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HENRY E. SIGERIST

ON THE

HISTORY OF MEDICINE

HENRY E

IGERIST

ON THE

HISTORY

OF MEDICINE

<m>

EDITED AND WITH AN INTRODUCTION BY

FELIX MARTI-IBAREZ, M.D.

PROFESSOR AMJ CHAIRMAN, DEPARTMENT OF THE
HISTORY OF MEDICINE, NE^V YORK MEDICAL COLLEGE,
FLOWER AND FIFTH AVENUE HOSPITALS, NEW YORK;
EDTTOR'IN'CHIEF, MD MEDICAL NEWSMAGAZINE

FOREWORD BY

JOHN F. FULTON, M.D.

DEPARTMENT OF THE HISTORY OF MEDICINE,

YALE UNIVERSITY SCHOOL Op MEDICINE

MD PUBLICATIONS, INC.: NEW YORK

LIBRARY O? CONGRESS CATALOG CARD NUMBER 60 6646

NEIV YORK, NEW YORK

This book IS protected by copynght No part of it may be duplicated
or reproduced m any manner without wntten permission from the publisher
Printed m the United States of America.

ACKNOWLEDGMENTS TO PUBLISHERS

Grateful acknowledgment is made for permission to reprint the following:

The Physician’s Profession Through the Ages: Bui/etin of The New York Acad-
emy of Medicine (second senes) 9 661-676, December, 1933

The Philosophy of Hygiene: BuHefin of the Institute of the History of Medicine
1 32S 351. October. 1983

The Social History of Rfedicine- Western Journal of Surgery, Obstetrics and
Gynecology 48 715 722. December, 1940

Developments and Trends In Gynecology: American Journal of Obstetrics and
Gynecology 42 714 722^ October, 1941.

Historical Background of Industrial and Occupational Diseases* Bulletin of The
New York Academy of Medicine (second senes) 12 597 609, November, 1986.

The Historical Development of the Pathology and Therapy of Cancer. Bulletin of
The New York Academy of Medicine (second senes) f 642653, November, 1932.

American Spas in Historical Perspective: Bulletin of the History of Medicine
JI 133 147, February, 1942.

Science and History Lectures on the Scientific Basis of Medicine, vol III, spon-
sored by the British Postgraduate Medical Federation, London, England, Athlone
Press, 1953 1954, pp 1-16

On Hippocrates: Buiietm of the Institute of the History of Medicine 2 190 214,
May. 1934

Medieval Medidne* Studies in the History of Science, Philadelphia, University of
Pennsylvania Press, 1941, pp. 43-54.

Bedside Manners in the Middle Ages: The Treatise De Cautelis Medicorum At-
tributed to Amald of Villanova; Quarterly Bulletin, Northwestern l/niversitv Afedi
cal School 20 155-143. 1946,

Sidelights on the Practice of Medieval Surgeons: Proceedings of the yfnnuof Con-
gress on Afedical Education, Hospitals, and Licensure, February, 1953, pp 18 19

Impotence as a Result of Witchcrafc: Essays in Biology. Berkeley, Calif, Uni-
versity of California Press. 1943, pp 541-546

ACKNOWLEDGNfENTS TO PUBLISHERS

The Foundatioa of Human Anatomy in the Renaissance: Sigma Xi QuaTterly
22:8-12, Mardi, 1934.

Taracclsus in the Light of Four Hundred Year*: Lecture delivered January 23. 1941,
at The New York Academy of Medicine, in the sixth series of Lectures to the Laity,
1940-1911, entitled “Art and Romance of Medicine.” Later published in The March
of Medicine, New York, Columbia University Press, 1941, pp. 28-51.

Ambroise Tati's Oaian Treatment of Bums: Bulletin of the History of Medicine
/f:H3-149, February, 1914.

lYilliam Harvey’s Pasition in the History of European Thought? Archiv fUr Kut-
tuTgeschichle /9:I58-I68. 1929.

A Boerhaave Pilgrimage in Holland: BuUeiin of the History of Medicine 7:257-275,
February, 1939.

Boethaave's InQuence upon American Medidne: Hederlands Tijdschrift voor
Geneeskunde 82:4822-4828. October 1, 1938.

An Elizabethan Poet's Contribution to Public Health: Sir John Harington and the
■\Vater Closet: Bulletin of the History of Medicine 74:229-245, February, 1943.

A literary Controversy over Tea in Eighteenth Cemury England: Bulletin of the
Hiflory of Medicine 74:185-199, February, 1945.

Medical History in the United States: Past-Prcscnt-Tuiuret A Valedictory Ad-
dress} Bulletin of the History of Medicine 22:47-64, January-February, 1948.

University Education: Bulletin of the History of Medicine 8:8-21, January, 1940.
Living Under the Shadow: Atlantic Monthly, pp. 25-30, January, 1952.

American TrufOes: A Thanksgiving Fantasia: Bulletin of the History of Medicine
72:402-409, November, 1944.

The Spelling of Proper Names, or the Importance of Being Ernest; Bulletin of
the Hutory of Medicine 74:521-524, November, 1945.

Tbougho on the Physidan’s Writing and Reading: Medical Writing, MD Inter-
national Symposia, no. 2, New York, hlD Publications, 1956, pp. 1-7.

Figure references and figures were deleted from the following essays:

Bedside Manners in the Middle Ages: The Treatise De Cautelis il7cdtcort«m At-
tributed to Amald of Villanova.

A Boerhaave Pilgrimage in Holland.

An Elizabethan Poet’s Contribution to Public Health: Sir John Harington and
the IVatcr Closet.

A literary Controversy over Tea in Eighteenth Century England.

TABLE OF CONTENTS

Foreword by John F. Fulton, MJ> ix

Introduction: The Mind of a Man
by Filix Marti-lbihez, M.D xiii

I. ON MEDICAL HISTORY

The Physician's Profession Through the Ages . . S

The Philosophy of Hygiene 16

The Social History of Medicine 25

Developments and Trends in Gynecology 34

Historical Background of Industrial and Occupational Diseases . . 46

The Historical Development of the Pathology and Therapy of

Cancer 57

American Spas in Historical Perspective 66

Science and History 80

II, ANCIENT AND MEDIEVAL MEDICINE

On Hippocrates • • 97

Medieval Medicine 120

Bedside Manners in the Middle A^: The Treatise De Cautelis
Medicorum Attributed to Amald of Villanova 131

VIll

TABLE OF CONTENTS

Sidelights on the Practice of Medieval Surgeons 141

Impotence as a Result of Witchcraft 146

III RENAISSANCE BAROQUE
AND AGE OF ENLIGHTENMENT MEDICINE

The Foundation of Human Anatomy in the Renaissance 155

Paracelsus m the Light of Four Hundred Years 162

Ambroise Par^ s Onion Treatment of Burns 177

William Harveys Position in the History of European Thought 184
A Boerhaave Pilgrimage in Holland 1^3

Boerhaave s Influence upon American Medicine 202

An Elizabethan Poets Contribution to Public Health Sir John
Harmgton and the Water Closet 209

A Literary Controversy over Tea m Eighteenth Century England 218

IV PERSONAL HISTORY

Medical History in the United States Past— Present— Future A

Valedictory Address 23S

Unuersity Education 251

Living Under the Shadow 269

American Truffles A Thanksgiving Fantasia 282

The Spelling of Proper Names or the Imj>ortance of Being Ernest 291
Thoughts on the Physician s Writing and Reading 295

Index

305

FOREWORD

the end o£ the final essay of this volume, “Thoughts on the
Physician’s Writing and Reading," Henry E. Sigerist gives us a truly
Homeric confession of faith: “what I wrote I Jiave lived, and it has
enriched my life so tremendously tJiat 3 thought others might benefit
from my experience," or, to paraphrase the old aphorism, "I am a part
of all I have read.” This undoubtedly exemplifies the spirit of Henry
Sigerist more aptly than any other sentiment in the volume. Also, these
essays indicate that Sigerist vns as greatly interested in men as he ^vas
in books— men of all lands, persuasions, and occupations— and so con-
scientious was he in maintaining lines of communication with his ever-
widening circle of friends that, toward the end of his life, his correspond-
ence became so vast that it interfered ss’ith his more serious ■writing.

During the summer of 1959, while attending international congresses
in South America (physiology) and in Spain (history of science), my
thoughts turned to him frequently, for, having seen him in action at
many such international gatherings, I knew full 'Ji’ell what they meant
to him. He kept detailed notes about them and generally on returning
home promptly sat do%vn to prepare a report for publication. For him
this ^vas contemporary history, something that needed to be recorded,
and his compulsions were such that he could no more go to a congress
and not record it than he could attend an opera and fail the next day
to tell someone about it, He never •wearied of sending cards to those

FOREWORD

who, for one reason or another, could not be present Such friendly
and kindly gestures he made in full measure This is well illustrated in
the essay A Boerhaave Pilgrimage to Holland,’ which records the two
day celebration m September, 1938, at the University of Leiden in
commemoration of the two hundredth anniversary of the death of
Boerhaave The two days will remain unforgettable to all who had
the privilege of attending the celebration Europe was m a turmoil with
every country mobilizing troops, but Holland seemed an island of
peace These phrases exemplify, incidentally, another of Sigerist s
tenets, namely, that the history of medicine, or of any other science,
should be portrayed in the framework of general history

Similarly, no American medical historian can forget Dr Sigenst s
great valedictory address, Medical History in the United States Past,
Present, Future in which he reported with almost complete objectivity
upon his fifteen year tour of duty in the United States during which
time he established the world s foremost center for historical studies
in medicine m addition to inspiring dozens of other centers and mdi
viduals— junior students and senior colleagues m every branch of
medicine— with the importance of the historical approach In retrospect
it seems almost inconceivable that one man could have accomplished so
much m such a brief space of time

Some have regarded it as a misfortune that he gave so freely of his
time and energy that he failed to achieve the great object on which he
had set his heart, namely, the completion of a formidable eight volume
history of medicine imtten on new and original lines There are others,
however, who feel that he achieved much more through the inspiration
of his essays and miscellaneous writings, many of which are reprinted
here for the first time, than he might have through his projected history

Sigerist approached true greatness as a writer because of his essential
humanity In his travels he gave as much attention to local cuisine and
the vin du pays as he did to the customs of the people and their literary
and cultural hentage His prose, moreover, was lightened by a gay wit
that has served as a source of endless delight to readers, young and old
In describing a dull book such as An Essay on Tea by Jonas Hanway
(1757) instead of boring us with Hanivay’s lucubrations about tea, he
draws a picture of the eighteenth century reformer as an entertaining
eccentric who launched sast schemes, such as trying to reform penitent
prostitutes and the Bank of England but who incidentally was respon
sible for inventing that great British institution the umbrella Hanway

FOREWORD

^vas indeed the first to tvalk the oft-moistened streets of London armed
with an umbrella; not being wholly sympathetic with the Gerroan-
American Ph.D. tradition. Dr. Sigerist asks whether a good title for a
doctoral dissertation might not be “From Hanway to Chamberlain, a
History of the Umbrella in British Lite." In Sigerist's hands the history
of medicine thus became identified with humanism, albeit in somewhat
unconventional form.

Even when his health began to fail, his outlook remained that of a
young man; for him, everything was of interest and what he saw became
history. For Sigerist, study of the past was the only sound way of
anticipating what lay ahead in any field of human endeavor.

John F. Fulton, M.D.

Haven, Connecticut
September, J9S9

INTRODUCTION
THE MIND OF A MAN

-iL HIS book is, by the power of the enlightening words it contains, an
immortal mirror of the luminous mind of a great medical historian. But
perhaps the best homage I can pay Henry E. Sigcrist is to say simply that
this book is a monument to a Man.

To be a man and to deserve such title is very difficult notvadays. In
times when society was based on individualism, as in the Renaissance,
the man who ventured to assert himself held in his hand the winning
cards in the game of life. This is why geniuses like Leonardo and rogues
like Casanova triumphed in the early centuries of the modem age, some
through the magic of genius and others through sheer rascality, but al-
ways through their fiery individualism. Today, to try to be a man, to be
faithful to Pindar’s dictum, "Become what thou art," to be loyal to one’s
OTvn real personal and inalienable destiny, is highly dangerous and,
though sometimes it leads to victory, is often a road to ostracism.

Henry Sigerist ^vas, in his own words, "a nonconformist.” a homo uni-
versalis who even in the heyday of the empire of "the masses," whom he
loved dearly and to whom he contributed so much, never renounced his
personality, his ideas, or his passionate individualism, although he knew
how harmful to him this could be among the Pharisees. Possibly his in-
dividualism was one of the intimate factors that resulted in his being
hemmed in by adverse circumstances and prodded into seeking the
peaceful environment of palm and vineyard under the azure skies of
Switzerland. Over there, his djiiamic spirit, unrestrained by frontiers of

XIV

INTRODUCTION

time and space, blossomed freely His mind, like Aristotle’s, was a vast
empire of culture incessantly lashed by gales of insatiable curiosity about
the life around him

But Sigenst s individualism was what made possible the legacy he left
us, which will breathe with life as long as man remains man His dy
namic philosophy of medical history will help us, now and in the future,
to face and resolve problems of health and disease by making the history
of the past a key to that of the future, and the shining example he gave
of courage, idealism, genius, and greatness, which, hke a mountain
shadow lengthening in the sunset, has grown only greater in stature since
his death, will be an ever stronger inspiration to physicians the world
over

The greatness of Sigerist is manifest in the supreme humanism with
which throughout his life he undertook almost superhuman enterprises
Prominent among these was the tvtiting of his great history of medicine,
which remained an unfinished symphony at his death

Sigerist s greatness rests upon his having been a man, nothing more
and nothing less, pledged to epic projects and great achievements, who
never for an instant relinquished his human quality, possibly because
he felt that there is no greatness higher than that of the human being
who makes his life a supreme endeavor to renounce nothing, not esen
his simplicity For greatness is simplicity It is doing great things that
change the life of mankind, keeping the spirit aloft in the heaven of
ideals but retaining one's supreme personal simplicity, even in ones
most glittering hours on the road to glory

Physicians and students will continue far into the future to read
Sigenst s works and to assimilate his ideas, as we all have done, making
of his concepts a compass for navigating the broad seas of medicine But
only those who knew him personally can fully benefit from the memory
of his presence and words, from that ineffable learning and feeling,
thinking and working, dreaming and creating, that were his life and
his example

Elsewhere* I have recounted my memories of Sigenst during his visit
to Spam and our last meeting in Rome On these occasions, acquaint-
ances and friends alike were amazed and charmed by this man who for
years had been spiritual mentor to so many physicians and yet retained
the enthusiasm and curiosity of a child, the sense of wonder, the enjoy
ment of life, the high spirits and strong emotions, and consequently the
SigCTwt and Spam Journal oi the Hutorj of Uedlane and Allied Sciences 13 1958

INTRODUCTION •

ability to convert the dry faded herbarium of medical history into a sun-
lit garden filled with the fragrance of roses and the hum of bees.

Sigerist ivas a great man, which is far superior to being a “big” man.
This greatness of soul and mind of Sigerist moves me to say here some-
thing that to some may sound like heresy, but that I, sincerely believing
it to be the truth, dare lay reverently upon his, in our memory, eternally
warm ashes: the best of Sigerist perhaps would be not a long, formal hiS'
tory of medicine but the articles and papers, notv scattered like flocks
of restless birds, that he published in his lifetime, some of which are col-
lected in this anthology.

Many people deplore the fact that Sigerist never completed his monu-
mental history of medicine. I do not think be would have ever finished
it. Had he done so, I do not think, great though it would have been and
undoubtedly the best work of its kind, that it svouJd have been the best
of Sigerist, Besides, I think that Sigerist did write such a history. One
need only peruse his works to prove that. It is not a history svritten in
the chronological order and organized form beloved by some, but in the
tvay he himself preferred, that is, in articles varying in theme and occa-
sion but unified by the thought that inspired them.

Sigerisc’s work, his articles and lectures, lead by paths full of beauty
and precision to all the problems of the history of medicine. When Or-
tega y Gasset died, some people regretted that he did not leave a com-
plete treatise on philosophy. Dr, Gregorio Marandn remarked at the
time: “What could a circumstantial and dogmatic treatise add to that
infinite curiosity and clarity that he [Ortega] put into everything?" Very
true. Similarly, Sigerist did not leave a complete history of medicine pos-
sibly because there was no need to do so, just as Einstein did not need to
leave a complete treatise on physics to ensure his immortality.

As a matter of fact, geniuses rarely have the patience, time, and desire
Co feave “comp^ece” works an chc fevorrce stcfr/jcc erf rfrevr iiscsikra. It
seems as though the genius w’ere fated to be a sublime catalytic agent that
creates, inspires, and stimulates but rarely has the opportunity— dented
by his life or restlessness— of devoting sufficient years to creating a defini-
tive work on his specialty. But even if he produced such a work, it could
never capture the brilliant light that the genius flashes forth in his mo-
ments of creation.

Geniuses are rarely good scholars in childhood— as ^vitness Santiago
Ramon y Cajal, a very poor student, who failed in anatomy, yet later
became the genius of neurohistology— perhaps because their creative

XVI

INTRODUCTION

nature instinctively rejects the routine and discipline that others less
gifted have no difhculty in accepting

Sigerist s work is a scattered mosaic tvhiMe pieces his disciples svill some
day assemble It would be sufficient to arrange chronologically selected
fragments of his articles—some day I myself may try to do this— in
order to have a history of medicine far more effectue and inspiring than
anything Sigerist might have written after laming the winged Pegasus of
his spirit into the plodding plow horse that the historian perforce be
comes under the burden of compulsory regimented writing Sigerist left
a great history of medicine All one need do to find it is look for it in his
writings his words his life

For a medical historian not only makes history with what he says and
writes but also with his person and his thought Like a catalyst of great
ness he inspires his surroundings Sigerist made history because life for
him was all light and clarity No one will c\cr again be able to make
medical history uninfluenced by Sigerist s ideas which have become
integrated into the thinking of physicians all over the w orld thus stamp
ing upon the beloved absent a supreme epitaph of unisersality
In this book we present a selection of Sigerist s works as made by the
author himself at my request some years ago svhen I suggested to him
the idea of publishing an anthology together with some other pieces
selected by myself as the best examples of his work The selection he him
self made at my personal request m hfarch of 1956 faithfully reflects his
personality He left out some important works on medieval medical
bibliography m which he so greatly excelled yet he included several
delightful articles on such subjects as hosv to spell his name and how to
prepare a truffled turkey on TTianksgiving Day That he chose those ar
tides for his anthology reflects better than anything else his great sim
phcity his deeply warm nature and his enchanting sense of humor He
never affected pompous postures He was fond of life kind simple and
merry even in the hours of his greatest professional renowm

Our editorial efforts on these pieces have been focused on arranging
them m some chronological order (by periods) and by subjects aviih
the object of helping the reader get his bearings Othenvise I have pre
ferred to let the master speak m the way he was fond of passing from
one theme to another alternating serious statements svith humorous re
marks always in that friendly conversational tone characteristic of the
true master who unimpressed by his otvn learning acts more like a com
panion than a tutor I have preferred to let his thought— on svhose

INTRODUCTION

xvii

mighty wings the sun of ideas shone as fiercely as the sun on the far-
reaching wings of the condor-range over time and space, continents and
ages, facts, figures, things, and places of hisiory-the history not only of
medicine but also of civilization.

Sigerist's great innovation is to have made the history of medicine a
facet of the history of mankind by linking it with the history of the cul-
ture, art, creeds and philosophies, economy, lechnolog)’, and sociology
of each period, thus binding the physidan’s endeavor to man’s yearnings,
struggles, and conquests in each historical epoch. This great contribution
of Sigerist’s as a historian can be compared only with the impact that his
presence, speech, and example as a man made on all of us who knew him.

Sigerist considered medicine to be a science natural in its methods and
social in its objectives. He placed medicine among the social sdences by
making it responsible not only for preventing and healing disease but
also for protecting the health and well-being of mankind.

The history of medicine was to Sigerist a powerful tool with which bis
mighty hands carved a statue to human well-being. His history is no mere
story about a coin, a parchment, an instrument, a statue, or a building.
He was a true artificer of history, in whose hands ev'erything instantly
acquired a dynamic character and was illuminated by the vivid light of
our osvn lime.

Let us emphasize that dynamic character, of living history, in Sigerist’s
work, for it illuminates all the ivritings contained in this volume. From
the sunny sands of the island of Ck)s, just as from Boerhaave's Amster-
dam, Harvey's London, or Paracelsus’ Zurich, Sigerist knew at once how
to extract an inference applicable to our own age, a lesson of enormous
practical value to the present-day physician.

History with Sigerist was never a static investigation of the past, but a
dynamic exploration of the present and an anticipation of the future. He
made history because history to him rvas learning from the past hmv to
interpret the present and antidpate the future. History never repeats
itself; hence sve must know it in order to re-create it at each instant svith
our effort. A sociologist of medicine, Sigerist always bore in his heart the
longing to help every man by offering him the best that medicine could
do for his health and well-being. For him medicine was not so much the
healing of disease as its prevention and the promotion of health.

But what I admire most in Sigerist is bis concept of the history
of medicine as a facet caived on the immense quarry of the history
of civilization. From his earliest vrarks, Sigerist knew how to get away

XVlll

INTRODUCTION

from the narrotv. ambit o£ history considered as a mere chronology o£
dates on a single subject so as to link medicine with the civilization o£
each epoch Without talking of philosophy, he had one of his oivn, prop-
erly organized, that allowed him to integrate medical knowledge with
all the other endeavors of man m time and space

Prior to Sigerist medical historiography, the study of the activities of
medicine suffered from being neither historical nor medical enough
Sigenst established from the start that the history of medicine must be
first bf all htstoryj but always medicine as well Its objective must be to
serve the physician s vocation by stimulating him enlightening him, and
serving him as a tool and a sjstem

At the same time, Sigenst knew how to combine m a clear and enter
taming prose the three ways of making history, namely, to describe the
lesser facts to narrate the important facts and to interpret the basic facts
In his polished and lucid style, he made pleasing and friendly history,
not grave and stern like the face of a professor of the last century, but
cheerful and dynamic like the face of a young sportsman of our time
This book contains all that and more It affords a complete perspective
of the history of medicine, requiring the reader only to fill in mentally
the gaps between one section and the next in order to complete the span
of the unfinished bridge chat Sigenst started, and whose curve can be pro-
jected mentally to reach over to the other side of the river of history
This book also contains a philosophy and a dynamics of history, a his
torical methodology that can be applied to any historicomedical study
Above all just as the breast encloses the heart this book contains the
soul of a man who like a crusader for humanism, lived serving an ideal
and died hoping for it

Teux W arti Ibanez, M D

New York City
September, 1959

ON MEDICAL HISTORY

THE

PHYSICIAN’S PROFESSION
THROUGH THE AGES

-xL HE characteristic features of the medical profession are determined
to a very large extent by the attitude of society towards the human body
and by the valuation of health and disease. The scope of medicine was
always the same; to cure disease and eventually to prevent it. Medicine
always meant service; therefore at all times certain qualities were re-
quired of the physician— readiness to help, knowledge concerning the
nature of disease, and skill in curing the sick man. However, the medical
ideal was a very different one in different periods of history, determined
by the structure of the society of the time and by its general conception
of the world.

Primitive medicine had a very complex character. While light ailments
• •’ ‘ no particular explanation and were treated by the patient or his

datives by drugs, special diets, and other rational means, serious ail-
■ ^ had to be explained, and the explanation tsras magical or religious.

%vas believed that somebody had done harm to the patient, and this
2body might be another man or a demon, causing the harm by imro-
an object into the body of the patient by means of magic, or by
/ing something essential to life. In other cases it was believed that
’ s^y had sent disease as a punishment for sin, or that a demon had
‘ possession of the patient’s body. According to these views, the
y, was either magical or religious, for an object had to be taken

' before Tire New York Academy tA Mnlidne, Oaober 18, 1953.

ON THE HISTORY OF MEDICINE

out, the removed part o£ the body had to be brought back, the deity
placated and the demon expelled The physician of primitive society
was therefore physician priest, and magician at one time He is called
medicine man according to the designation given him by the North
American Indians, or shaman, as he was called in the Siberian tribes His
life was a hard one He nas paid according to the success of his treatment
If the patient died, he might be suspected of having caused the harm him
self Being skillful in the art of magic, it was believed that he was able
not only to remo\ e a spell but to do harm as well by means of magic In
many tnbes shamanism was liereditary, m others one ivas bom to be a
shaman Particular events at the time of birth (a child being bom with
a tooth) or events in early childhood (a child having survived an accident
which othenvise would have been fatal) seemed to designate a child as a
prospective shaman The young one ivas trained by another shaman until
he ivas consecrated and became independent In some African tnbes the
medicine man was a farmer like the other members of the tribe and prac
ttced his art only occasionally, white m most other tribes the shaman
lived a segregated life, apart from the other members of the tribe
In Babylonia the physicians were pnests The Babylonian civilization
had an entirely religious character, and all sciences were a part of the
ology Their purpose was to keep tlic gods benevolent or to placate them
if they v^crc oUcndcd In order to know the intentions of the gods, one
had to observe and interpret the omens the signs through which the gods
revealed ihcir intentions All Babylonian sciences started this way, and
so did medicine The pnest physician watclied the stars, a flickering flame,
a drop of oil poured into water, the organs of sacrificed animals, m order
to know what the fate of the patient would be and to be able to counter*
actit Omens however, ircrenotonlytlicphenomenajustmentioned but
the $)'mptoms of disease as well These, too, had to be observed carefully
and given a meaning Tlicy were described and studied with great care,
and in this way rational possibilities were given to medicine without
leaving disregarded the religious attitude The treatment consisted chiefly
of incantaiiom, and a great man) texts give a very gnpluc description of
the pnest physician dressed m the red cloak, a raven in one hand, a falcon
in the other, pronouncing the incantation over die patient
At all limes the physiaan’s profession gives him power He knows
poisons-clicmical, physical, biological forces of high potency arc given
freely into hu hands Secrets arc divulged to him, v\hich also gives him
power over die pauenu A misuse of this power is a serious menace to

THE PHYSICIAN’S PROFESSION

society, and so at all times society endeavored to protect itself by estab-
lishing rules regulating the physician's behavior. The first regulations of
this kind are found in the Code of Hammurabi (2000 b.c.) rvhere a tariff
is established. The surgeon’s fee varied according to the social standing of
his patients. Moreover, the surgeon tvas declared liable for his doings, and
in case of a fatality in an operation his right hand rvas cut off. We find
similar regulations in ancient Persia, in one book of the Avesta, the
Videvdac, which contains extremely interesting regulations according to
rvhich a surgeon was not allowed to practice before he could show three
successful operations performed— not on Parsees, but on infidels.

In Egypt, the physicians belonged to the class of the scribes. They, too,
were sometimes priests, but not exclusively, as svas the case in Babylonia.
They received their medical training in the schools connected with the ’
courts, the chancelleries, or the temples, the most famous of tvhich ivere
in On, Memphis, Thebes, and Sais.

When the Greeks began to travel to Egypt, they recognized in the
Egyptian god of healing, Imhotep, their own Asklepios. Yet there were
two entirely different deities— Imhotep, originally a man, a great scholar
and architect, ivho lived in the time of King Doser, and who aftenvards
was heroized— Asklepios, on the other hand, a local demon in Thessaly, a
chthonic deity. According to legend, Asklepios tvas cut out of his mother’s
womb by Apollo, whose arroivs had killed her. The child Asklepios was
brought to the cave of the centaur Cheiron, svho taught him the medic-
inal virtues of herbs and many incantations. In this way, Asklepios be-
came a physician who cured many sick men, and he even resuscitated
some who were already dead. Zeus struck him tvith his thunderbolt for
such presumption.

This legend has a deep meaning. It means that the physician’s interfer-
ing with the laws of nature is not obvious but represents an enormous
fiybrfs. AndFfato still felt the necessity oejastifying the physician through
the argument that the state needs healthy citizens. Asklepios SN*as wor-
shipped in many temples, and it was believed that his priests, the Ask-
lepiads, were the first doctoK of Greece. This, boivever, is not correct.
The medical practice in these temples consisted in miracle cures. It was
a purely religious medicine, which has nothing at all to do with the heal-
ing art that originated in the scliools of the pre-Socratic philosophers and
found its highest expression in the school of Hippocrates. The Hippo-
cratic physicians called themselves Asklepiads also. They did so because
they were organized in a kind of guild, the patron of which was Asklepios.

ON THE HISTORY OF MEDICINE

The Greek physician, however, was a craftsman He received his tram
ing by going to another doctor as an apprentice Like the other craftsmen,
he traveled a good deal and practiced his art rvhile wandering There
were not many doctors in ancient Greece, only the larger cities had their
otvn doctor, rvhose salary ivas raised by a special tax, and rvho was in the
city service In times of war or epidemics, special physicians ivere ap
pointed, but all the smaller places had no doctor, and the medical service
was given exclusively by wandering physicians who happened to come to
such a place

We do not like the idea of a Greek physician being a craftsman, going
from one city to another, knocking at the doors, and offering his services
as a shoemaker or a blacksmith would And yet there is no doubt that that
was the case Several Hippocratic treatises give us very enlightening ac-
counts of such occurrences There was very little privacy in the relations
between doctor and patient The doctor’s shop, the latreton, like other
craftsmen s shops was open to everybody, and medical questions were dis
cussed publicly in the market place When it happened that two doctors
came to the same tovm at the same time, a wild competition was the result
of such a coincidence Again, the Hippocratic writings tell us how many
doctors tried to attract the patients’ attention by dressing extravagantly,
being profusely perfumed and by displaying showy instruments Dr
Ludwig Edelstem has demonstrated very convincingly that the art of
prognostic developed in Greek medicine to such an extent chiefly on
account of these peculiar conditions in medical practice The doctor who
came to a small city generally ivas unknown to the population The best
way to secure a good reputation was by making correct prognoses and by
telling the patient right away what his disease was without even asking
questions

Being a craftsman who worked for his living, the social position of the
Hippocratic physician was not a high one And yet of all craftsmen he
undoubtedly was one of the most highly esteemed, and this was on ac
count of the attitude of the Greeks towards the human body

The Greek world was a world of the healthy and sound Health ap
pieared to be the highest good The ideal man, to the Greeks, was the
harmonious being whose balance m soul and body is noble, beautiful,
and perfect Disease was considered a great curse because it removes man
from the condition of perfection and makes him inferior The physician,
therefore, whose duty it is to maintain and restore health, was as highly
esteemed as a craftsman would be

the PHYSICIAN'S PROFESSION

toVmmign.o. Th=y «crc adventurer., m«tl,, and uere
by tbc Romans. Their superior noss g . ^ surgeons had

nired, and frequent wan jf , physicians was entirely

■he result that the policy L „uch as possible. In

changed, and that they were a physicians on Roman

40 B.C.. Julius Caesar presented all tree ^ Augtis-

soil with the right of Roman cimensl R accorded to physi-

tus hnighted his were hee of taxation, free of mill-

cians became still greater. i taVing lodgers and of accepting

tary service, and free of “Xis a ;hysician in antiquity?

ofTices, But now the great ^ „„i„isity which could deliver

There wais no state conuol of any „„„ „„pring it

a recognized degree. The grc P go a certain

became to call oneself a P''?”''’" ‘",7" a in the time of Antoninus
amount of restriction becarne "“^according to which in all Ronaan
Piusaniimenisc/aiistuwasintr ’ gjog to the size of the city,

cities only five, seven orten 7‘7'„7°,,a Jde docti, and in order to
should be so privileged. These we possessed medical knowl-

attain to that rank they ^^/ticCe - ^thu'ted, which guarded the
edge. In this way a kind of license

rights of competent physicians. physician. They gave

to Romanrimes, many Ihe” hofe Imily during that

him an annual salary tor which he treate^i But we

year. A body-physician at court ^ 7l income amounted to about

hear of physicians in the capita who ^ ,,ho charged as much

$35,000'^ And there PX™ “" cial cures or operations. This of

as from 52,000 to $10,000 for their special

course rvas exceptional. rnedical societies in

Through inscriptions w-e know *at here^^ of their pa-

Roman Empire. Their chief pur^« ^^ese societies, ^

trons Aesculapius and Hre'' Inowledge and to '

deavored to improve the physi^a J, for the most brd-

zeal. The medical society of EP^7^^„bors during the year, or for th
liant cure effected by 77

invention of the best surgical instrument.

ON THE HISTORY OF MEDICINE

The position of the sick man and the physician in society was radically
changed by Christianity, ishich came into the world as the religion of
healing The new teaching appealed to the sick, the weak, and the
crippled, in sharp comparison with the old religions which were essen
tially for the sound and pure It promised healing both spiritually and
physically Did not Christ himself work cures? While in the Semitic
world disease was considered a punishment for sm, while among the
Greeks it produced inferiority, in the Christian world disease meant
purification, disease therefore became grace The sick man is a person
IS ho has obtained a share in the grace of God Taking him in is the duty
of the Christian and benefits the soul of him who does the good deed
Hospitals were erected, and. from the sixth century on, the convents and
monasteries made the sick their especial care But the care of the sick is
not medicine Christ had cured without drugs There was hardly any
room for the physician in early Christian society, and Greek medicine
was considered pagan art Christian pupils of Galen were cxcommuni
cated because they dcNoted their time to this heathen science Over and
over again, one endeavors to justify the physician by quoting the words
of Ecclesiastes, according to which the physician had to be honored be
cause he was a necessity, and because he, too, was a creature of God
Recognizing that the sick people could be taken care of much more effi
ciently not only by nursing them but by giving tJiem medical treatment,
the church reconciled itself with ancient medicine Cassiodorus, the great
chancellor of Theodoric, m the sixth century, had medical books in his
library, and the Benedictines, following his example, began studying
medicine also

In the earl) Middle Ages most of the physicians iscre monks Monas
tcrics had special rooms de\oted to the care of tlie sick, and tlie cloisters
became centers of medical study There m the cloisters medical l>ooks
vsere copicil, were compiled, and it was not always done uncritically A
monk in the monastery of St Gall, cop)ing the herbal of Pseudo Apu
Icius, left out all the plants that did not grow in bis country, and replaced
them by describing native herbs Tlie medical literature of the early
Middle Ages, however, v\as not original It v\a5 chiefly compiled from
ancient sources but m ihjs way Creek medicine and tfie principles of
Greek therapy were observed

v\s these metlicval piqstcians belonged to the clergy, their ethical
stamUrds were directed by the church, and continued to be so directed m
the later .\fiddle Ages as well, when a great many laymen had joined the

THE PHYSICIAN’S PROFESSION

medical profession, because doctors and patients, whether clerical or lay,
were firet of all Christians. The church declared it the patient's duty to
consult a phj'sician. The sick man who avoided treatment harmed him-
self* *^0 harm oneself is sin, just as suicide is sin. Medical service is to
preserve life, just as eating and drinking does, and it is the duty of a
Christian to do whatever he can to preserve the abode of the soul. A
Christian patient could not call in an Arabic or Jewish physician. If he
did so, he W’as apt to be excommunicated. The superiority of the Arabic
and Jewish physicians, hosvever, svas so evident that it was impossible to
enforce this rule. On the other hand, it is the doctor’s duty to treat all the
patients, even hopeless cases- In sharp contrast to this were the ancient
Oriental and Greek conceptions, where the doctor considered it unethi-
cal to attend a case in wliich his help would be of no use. It was further
declared to be the doctor's duty to give free medical treatment to poor
patients, and in some cases even to provide them with drugs gratuitously.
The doctor ivas made liable for his doings, and it was his duty to follosv
the traditions.

The church, hosvever, did not approve of its ministers occupying them-
selves sviih medicine. After all, medicine was a worldly art. Surgery was
considered particularly unsuitable for the priests, because any operation
might be fatal, and ilie priests were not allowed to underuke anything
that could lead to death. From H31 on, edicts svere passed restricting the
clerics from medical work. The fourth Lateran council in 1215 forbade
the priest taking part in any surgical procedures. The surgeons, there-
fore, were more and more frequently laymen.

In the tenth century a medical school began to develop in Salerno. It
flourished in the twelfth century under the inspiration of the new trans-
lations of medical books that were made from Arabic into Latin. The
Salernitan school u^as not founded by the church. The doctors were lay-
men as well as clerics. The chief importance of the Salernitan school
lies in the fact that it created a new literature which, although it was not
original in itself, following ancient and Arabic sources, still improved
considerably the medical knowledge of the time. In 1224 the Emperor
Frederick 11 published decrees regulating the medical conditions of his
empire— decrees which are particularly interesting, as it is the first time
in European history that medical practice was strictly regulated by pub-
lic law. The right to practice medicine svas made dependent upon the
ability to pass certain requirements. The medical curriculum compre-
hended three years’ study of philosophy, five of medicine, and one of

ON THE HISTORY OF MEDICINE

practice. The candidate had to pass an examination in Salerno, after
which a license -vvas delivered to him. ^ It was

Salerno was the first medical faculty of the occtdeirial ‘
followed by the institution of univetsUics all over Europe.^ 1 medi-
and thirteenth centuries brought a great many new
cal books from Arabic into Latin, and it became tl\e cliief task o
versities to interpret and assimilate the new literaiure. The met lO
the Aristotelian dialectic, and the result was scholasticism in the es

it was in the East. Medical education tvas purely theoretical.

It would be a mistake to assume that medical practice was chiefly
cal in the Middle Ages. There svas a religious medicine, to he
there always was and still is. And it is obvious that in a period in w ic
all sciences were dominated by theology, the religious clement m me
cine was stronger than at other times. The principles of medical practice,
however, still were the principles of Greek medical science as is clear y
shown by the medical textbooks and by the ConslUa in which the physi-
cians discuss definite cases.

In the thirteenth century we encounter a very highly developed sur-
gery, the roots of which are hard to trace. The reason for this is that at
this time the surgeons in Italy were educated at the universities, and
wrote textbooks, while before, and outside of Italy, the surgeons ivere
uneducated craftsmen who did not write. Surgical operations had ahvays
been perfomed, but we do not hear of them. Surgery has a different
tradition from, that of medicine. It is to a very large extent independent
of any literature and is transmitted by word of mouth from father to son,
and from master to pupil. In most countries of Europe, the surgeons, like
other craftsmen, were organired in guilds. They were barbers, were bath
keepers in the German countries; their field was limited to the treatment
of wounds, to the lower surgery. In the beginning of the thirteenth cen-
tury, the College de St. C6me el St. Damien was founded in Paris. Its
members were divided into two categories— the surgeons of the long robe,
among whom there were still clerics, and those of the short robe. There
were endless conflicts between the surgeons themselves, and between
surgeons and physicians.

From the founding of the universities on, the physician was a scholar,
a doctor, and has been so ever since. In the Christian Middle Ages, pro-
fessions were considered vocations, divine missions from which definite
duties towards God and one's tcllowmen were derived. The rise of capi-
talism brought in a different conception. Economic aspects rvere stressed.

THE PHYSICIAN'S PROFESSION

A profession became more and more a means to earn a living. To the
honor of the medical profession, it must be said that the old medieval
conception of the profession has been preserved to our day, more than
with most other professions. I have never heard of an engineer building
a bridge without remuneration. And yet, from the sixteenth century on,
the economic aspects were more and more influential in the develop-
ment of the profession.

Tlie physicians recruited themselves from the middle classes. The best
that could liappcn to tliem svas to be body-physician to a person of high
rank. This gave tlicm a definite income, and thus the opportunity of
devoting much of their time to charily tvork. The monarch had a whole
staff of body-phy-sicians and surgeons, and the aristocracy, u-hether
worldly or ecclesiastical, followed the monarch’s example. In the more
democratic countries, like, for instance, Switzerland, a doctor was at-
tached not to tlie court of a nobleman but to a family or a group of
families. The family physician is the democratic form of the body-physi-
cian.

The rise of democracy at the end of the eighteenth and in the nine-
teenth centuries abolished the class privileges; the profession 'vas open to
everybody. Individualism and liberalism became evident. Health and
disease were considered a private matter of the individual, so much so
that in Germany in 18G9, at the instigation of the Berlin Medical Society,
medical practice was opened to everybody, even to those who had never
studied medicine. This is a typical example of nineteenth century liberal-
ism. The law svas justified by the arguments that there always had been
quacks, and there always would be, that man had a natural right to
choose his healer, and that the people, being reasonable, would know
how to distinguish a real doctor from a fake one. Rudolf Virchow rvas
responsible for this development to a very large extent.

Democracy undoubtedly was a great advance. It gave everybody a
chance. And, as the great Christian humanitarian ideals were fully alive,
a successful man felt his obligation to help those who had not been suc-
cessful in life. A great deal of charity work was done; more hospitals svere
erected than ever before.

In the nineteenth century the doctor svas a member of a highly re-
spected liberal profession. An academic education was highly regarded
and rewarded its owners ^vith great social privileges. The natural sciences
had developed by leaps and bounds, and the doctor, being a representa-
tive of the natural sciences, was so much the more esteemed- Although

ON THE HISTORY OF MEDICINE

very few physicians ever became wealthy, the majority of them had a
decent income that made it possible for them to give free medical care to
die poor For a considerable time the hospitals were exclusively chanty
institutions and it was quite obvious that in most cases the doctor did his
hospital i\ork without any remuneration I still remember the time
when in Europe the doctor did not send bills and received from the
different families certain amounts of money for Christmas
These times have gone The world has changed and the medical pro
fcssion today is undergoing one of the greatest revolutions in history It
IS a revolution not of medicine but of medical service During the nine
tecnth century, the profession was absorbed by research problems Medi
cine has made more progress and has become more efficient than ever
before in history While all efforts were tending towards advancing our
knowledge of the disease mechanisms comparatively little was done to
organize medical care And as a matter of fact little had to be done as
medical service kept on being eflicient by following traditional lines
The situation is entirely changed today And it is so changed for differ
ent reasons Medicine has become more and more technical and more and
more specialized During the eighteenth century the faculties of the
nietlical schools began to devote more and more of their activities to

medical research In the nineteenth century, the research methods be
came greatly complicated and the consequence was that the research
Worker necessarily had to specialize The result of this specialization in
rese-irch was that teaching too became more and more specialized as
most of the European universities had the principle that a medical subject
should not be taught except by men who had done active research work
on It In 1833 Johannes Muller was appointed in Berlin as Professor of
Anatomy Physiology, and Pathology After his death the chair had to be
sp It up into three chairs The next step finally, was the specialization of
mctlical practice, which u still increasing
Spcciali/ation m medicine is not a new phenomenon When Herodotus
tn\ c «1 in Fgy pi m the fifth century b c he found specialists ev crywhere
^octors for all organs and for all diseases The same occurred in the
K«.man Fmpire Wlulc Hippocratic physicians were general practi
oners m i le asi centuries of the Roman Empire there were specialists
^"herc m Rome This means iliat m all civilizations a point was
ic m w iifh medical knowledge seemed so vast that it could not be
nu^tctnl by one single man and specialization followed of a necessity
■nirmi,.h specialization, medicine today has become more efiiaent than

THE PHYSICIAN’S PROFESSION

ever before. And yet it certainly its disadvantages. The physician
who, his whole life long, deals with a limited group of diseases becomes
necessarily one-sided. The patient, on the other hand. %vho in the begin-
ning of specialization used to consult a family physician first and was
eventually sent to a specialist through him, today makes the diagnosis of
the affected organs himself, and it is he who decides to which specialist
he shall go. A very promising attempt to find a way out of this situation
is the development of group medicine, where doctors of different special-
ties join to form a clinic.

IVhat made medical progress possible svas the gigantic development of
the natural sciences. There ^vas extraordinary development at the same
time, in another field— in technology— and the result of this was the in-
dustrialization of the modem world. The same elementary force that
made medical progress possible had changed the aspect of the tvorld so
profoundly that the doctor has difficulty in finding his place in this new
world tvhich is ruled by iron economic necessity. The number of doctors
grew, and a ruthless competition arose. While the doctor of yesterday did
not need to bother about his bills, today be has to merchandise his serv-
ices. He has to find out what the cash value is of each service he performs,
just as a grocer has to do. The more efficient medicine became the more
complicated and the more expensive it was, and the more difficult it was
for the doctor to give free medical care. Today, therefore, we are in the
very serious situation that we run the risk of seeing a great effort wecked
by maladjustment.

Long ago an attempt to deal with this situation was made in Europe by
the introduction of social insurance. Sickness insurance was introduced
first in Germany not by the socialists but by Bismarck and the consers’a-
tives, -which is very often overlooked. Sickness insurance for the com-
raunitj is the cheapest way to take care of the poor patients, because it
makes them take care of themselves by saving part of their tvages in case
of sickness. There can be no doubt that the sickness insurance in the
different European countries has had very remarkable results for the
people’s health. Germany, soon after a lost war, famine, revolution, had
health conditions that were just as good as those existing in the victorious
countries. And the compulsory sickness insurance is surely to be made
responsible for this, to a very large extent. And yet it is beyond question
that the 'different insurance sj^tems, as they are working in Europe today,
had very serious drawbacks. A new type of medical service svas created,
but one that endeavored to preserve the old forms as much as possible.

ON THE HISTORY OF MEDICINE

The doctor, in most cases, still ^vas paid according to his individual serv
ices, and as the insurance companies had not unlimited means the fees
sometimes ivere very inadequate On the other hand, abuses on the part
of the patient as well as the physician occurred, so that both patients and
doctors had to be controlled The result was a huge administrative raa
chinery with endless red tape

The next step in the development was the one undertaken by Russia
where the whole working population is insured against sickness, and
where the same position is given to the doctor as the other professions the
priest, the judge, the teacher, already have in other countries

We medical men have a strong espnt de corps We have a glorious
history, and we are justified in being proud of it What unites us is that,
unlike other professions, all of us, whether we work at the bedside, in the
laboratories, or at the writing desk, have but one purpose to benefit the
sick man We have developed strong professional organizations from the
very beginnings of our history The Greek doctors had their guilds, their
codes and their ethics, as did the medieval surgeons The medieval physi
Clans were members of their faculties, which were very powerful organi
zations From the sixteenth century on medical societies det eloped,
which today all over the world are very influential bodies All this neces
sarily makes us very conservative, but we must have the courage to face
the present day situation openly We must not be afraid of words, which
so often are incorrect, and the meaning of which is not seldom obscure
to those who use them We have a very absorbing profession— from the
first day we enter medical school, we have to work hard, and this leaves
us little time to see or to watch what is going on around us And m this
way It might happen that many of us have not quite realized how fast the
world IS changing its aspect There is a strong trend away from mdivid
ualism Health and disease ate no longer considered a private matter of
the individual fn many countries, laws have been made to enforce
health Society more and more feels responsible for the welfare of all its
members It has placed the means of retaining or regaining health within
the reach of everyone, and m return it may well demand health of the
individual We may like this development or we may dislike it, but we
cannot help it All of us are dependent on each other If large parts of the
population suffer, it is quite obvious that the rest will be affected by it
To us medical men, the idea that one sick organ affects the whole organ
ism should be familiar

There is one lesson that can be derived from history It is this that the

THE PHYSICIAN’S PROFESSION

physician’s position in society is never determined by the physician him-
self but by the society he is serving. We can oppose the development, we
can retard it, but tve will be unable to stop it.

The history of the medical profession today has reached a crucial point,
and it is our duty to save the efficiency of a noble profession that not only
has a great past but a still greater future. 1 would like to close by repeat-
ing Tvhac J have jvrltten once before; never before has societj' presented
the physician with so wide a field of activity and with so much influential
power. If never before, certainly today the doctor may become a states-
man, the Asklepios politikos visualized by Plato.

THE PHILOSOPHY OF HYGIENE

<w>

William Osier called the nineteenth century the century o£ pre
ventive medicine There can be no doubt that it tvas m the field of
prevention of disease that modem medicine attained its greatest achieve-
ments Our life IS no longer shortened by diseases such as leprosy, plague,
smallpox, and rabies Our life expectation is about twice as long as it was
half a century ago Great masters of the science of public hygiene, among
whom IVilham T Sedgivick was one of the outstanding figures, have
improved tlie methods of the applied science of practical sanitation In
all countries of the world great sums of money are spent every year for the
improvement of sanitary conditions, and never has money been so well
invested "We have decided to combat disease with all means available A
gigantic battle is going on all over the world against disease, the most
dangerous enemy of mankind The tvatchtvord is the dictum of Her-
mann T Biggs, which became the device of the Department of Health
of New York State ‘ Public health is purchaseable, within natural hmi
rations, any community can determine its own death rate ”

In 1924, Dr William H Welcli delivered the Second Annual Sedg
svick Memorial Lecture It must have been an unique experience to hear
a leading American prime mover of public health pay tribute to the
life work of a colleague m the same field Dr Welch spoke on the theory

Sedgwick Memonal Lecture delivered at ihe Maisachusetli Institute of Technology. De-
cember 1 1931

THE PHILOSOPHY OF HYGIENE

and practice of public health. He gave an admirable historical review of
the medical ideas which made the great achievements in public health
possible. I will not repeat what Br. Welch has already said much better
than I could possibly do. My oxvn work lies not in the field of practical
sanitation. I devoted my studies to the investigation of the history of
medicine and most particularly of tlie relations of medicine to general
civilization. The evolution of medicine cannot be studied separately.
M^icine is a phase of the general culture of the times and has ahvays
been strongly influenced by the general Weltanschauung.

For a great many years I have been fascinated by the history of hygiene.
I investigated its development throughout the different periods of his-
tory, and I hope to be able to publish the results of my study in a not too
distant future. Today, let me give you a short review of the general ideas
that led to the development of modem hygiene and more particularly of
the cultural and philosophical background.

It is quite obvious that the means and methods used in the prevention
of disease are those provided by medicine and science. And yet whether
tliese methods are applied or not does not depend on medicine alone but
to a much higher extent on the philosophical and social tendencies of the
time. Hj-gicne can only be successful if the population responds to it.
Sanitary measures can never be carried out by the medical man alone.
They need tlie cooperation of the governments. A few examples will
illustrate this attitude best.

We know little of the basic origins of hygiene. Empirically, guided
by his instinct, man learned to distinguish what was good from xvhat was
harmful. The taste of different herbs indicated their effect to a certain
extent, and so we must admit that a certain amount of hygienic knowl-
edge was acquired empirically at a very early period. Primitive medicine
has a very complex character. It has three different components: empiri-
cal, magical, and religious. Disease was attributed to the influence of
magic or to malignant spirits which were thought to take possession of the
diseased man, wherefore the means of protecting oneself against disease
were magical and also religious. TTirough amulets and magical pro-
cedures people tried to counteract malignant influences.

As civilization reached a higher stage, magical beliefs that at the time
had been generally accepted came to be regarded as mere supentitions;
religion attained a higher plane, and here, in the cult of ancient religions,
we find the most important roots of hygienic thinking. All ancient re-
ligions demanded that a man who enten the temple, who comes into the

ON THE HISTORY OF MEDICINE

presence ct h.s god, be clean 0£ course, th.s

imply spiritual cleanliness But it teas necessary that this

linL should hate an outward expression The priest was

less garments He avoided touching unclean thtngs, and so *

camfto the temple in order to worship his god had to be clean also
though the cleanliness svas taken m a spiritual sense, it had f

consequences All ancient cults demand such a ^

cepts are probably most distmaly defined m Leviticus, where we
great many regulations concerning the daily life of the Jew Thes
were not based upon hygienic reasoning, and yet they served to imp
hygienic conditions vastly Thus it rvas postulated that only
mals should be set apart to be eaten, that such animals should be
tcred alive with an unnotched knife, and that only animals were to
slaughtered that had no disease or injury In this way only soun
were slaughtered and the method of slaughtering ensured free b ee m
so that the meat was belter preserved

It was much the same with the other laws The man who becomes u ^
clem must be purified before he steps into the temple, and the ntua
punfiation required that the clothes of the impure man be washed an
that lie lumscU had to bathe Uncleanliness is contagious ^Vhoevc
touches an unclean man becomes impure himself The menstruati g
woman was considered unclean for seven days The woman in labor wa*
unclean from the moment her puns began and remained unclean o
forty da>s after dcUv cry if her child were a boy and eighty days if it were

a girl Man becomes unclean by pollution Gonorrhea was known i

the

ancient Orient The man who had a discharge from the urethra had to
take Ins place outside the camp AU his possessions were considered un
clean and he himself remained impure for sev en days after the discharge
ceased Tlicn he had to purify himself by w’ashing his clothes and bathing
Impure to a still greater extent was the man who suffered from a disease
called Zaraath, which probably included leprosy The man suspected of
having the discnsc was to be reported He was brought forth to the pri«*'
was examined and isolated When, m the Middle Ages, leprosy became
widespread all over Europe and physicians felt themselves unable to com
l>at the scourge cfTicicntly, it was the church that fought the disease W
applying the prescriptions convcyctl m Leviticus Lepers were isolated
everywhere and when, in the fourteenth century, a great epidemic of
plague ravageil all Furopc the same principles were followed In ih‘*
way. the leading motives of public hygiene were derived not from medi

THE PHILOSOPHY OF HYGIENE 19

cal concept, but from religious ordinances originating in the ancient
Orient.

And another institution of great hygienic significance has come to us
from Judaism: the iveekly day of rest. In Babylonia, the seventh, four-
teenth, twenty-first, and twenty-eighth days of the month were unlucky.
No work was done on such a day. The Jesvs adopted this institution from
Babylon but gave it a more ethical significance. It became the day of the
Lord, tvhich was dedicated to rest and worship. Christianity and Islam
adopted this custom, tvhich has proved to be of great hygienic con-
sequence.

It was the great contribution of the Greeks that they created a system
of personal hygiene which set an example for all time. They did it not
on account of medical considerations but through their attitude toward
the human body. The Greek world was the world of the healthy and
sound. Health appeared as the highest good, the ideal man was the har-
monious man, ^vho is perfectly balanced, mentally and bodily. The ideal
man is healthy and beautiful. The aesthetic ideal svas at the same time a
hygienic ideal. Greek education tended to develop man into a harmoni-
ous being. Education, therefore, was not one-sided; it trained the body
as well as the mind. From the sixth year on, the Greek boy was taken to
the palestra and was uught physical exercises. At sixteen, the young man
was instructed in the use of weapons in the gymnasium. We have a very
interesting description of how man should live in order to be healthy, in
the fragment of a fourth century doctor. Diodes of Karystos. He tells us
that one should get up before sunrise, bow one has to wash, to brush
one’s teeth. He describes the physical training. Twice a day he is to report
to the gymnasium. There are only trvo meals a day, and the dishes recom-
mended are simple.

But in Greece, also, iiygiene fallowed lelrgrocrs mley. Tt'e find (hcca
especially in the school of the philosopher Pythagoras. In the sixth cen-
tury B.c. he went from Samos to southern Italy and founded there a
school which had more the character of a religious order. The members
of that order had to lead a dignified life. They were restricted to a certain
diet, which was intended to keep up their balance, to make them resistant
against all disturbance from the outside ivorld. The ideas of Pythagoras
influenced Greek medicine toa large extent. They are chiefly responsible
for the theory of the four humors, which were thought to constitute the
substratum of life and disease. The Greeks were responsible for the de-
velopment of a highly refined personal hygiene. But we must not forget

ON THE HISTORY OF MEDICINE

that this hygiene ivas not general It affected only the upper social strata
The great mass o£ the common people, the slaves, farmers, and laborers,
had no part m it

While the Greeks upheld a code of personal hygiene which ivas to be
the model for all times, it was the merit of the Romans to develop pub
he health An effective public health organization is possible only where
there is a strong and steady government Greece tvas split up into little
states tvhich were fighting each other all the time In Rome, the condi
tions were much more centripetal Roman organizing power gave a tre
mendous impetus to public health As far back as the time of the kings,
laws were passed ordering that the dead be buried outside the town We
can still see the mighty arches of Cloaca Maxima and the great aqueducts
On eleven aqueducts through eighteen conduits, tvater was brought to
the city Four are sufficient today to make Rome the city having the best
ivater supply in Italy Descriptions of the city of Rome in the fourth cen
tury A D tell us that at this time the city could show eleven great thermae,
856 baths 1352 water basins and fountains, and fifteen sources Nearly
every house had its oivn water cistern, and from 1 1 b c on no tax had to
be paid for the water

With the passing of antiquity personal hygiene deteriorated Where
hygiene was to be a means it became the goal in itself The result tvas
contrary to what was intended sports became athletics, bathing was no
longer a means of being clean but led to effeminacy The world had
groivn decadent

Christianity produced a strong reaction The new religion found its
disciples chiefly among the lower classes of the population who took no
pan in hygiene or, at least, a very small part, and first of all Christianity
had an entirely different attitude toward the human body The Chnstian
conception was strictly dualisttc, mind and body are in opposition, and
what matters is the soul ^Vhy, then, care for the body, i e , the earthly,
sinful part of man? It is obvious that such an attitude was not favorable
for the de\elopment of hygiene The great hygienic achievement of
antiquity ^anlshed not merely because the first centuries of the Middle
Ages were hard times troubled by wars, it vanished chiefly because of
that different attitude And yet in the Middle Ages, too, people wanted
to lead a healthy and joyful life It is true that the body is the perishable
part of man, but it is the abode of the soul and is therefore to be pre-
served md to be cared for too, whence the church reconciled itself with
medical science and attempts were made to improve sanitary conditions

THE PHILOSOPHY OF HYGIENE

We know a great many regimina sanitatis, the most containing simple
rules for health, some in prose, some in verse. The best knoivn is the
regimen attributed to the school of Salerno, tv'hich was translated into a
great many languages. Bath houses were erected where one could take a
steam bath and -where the barber-surgeon gave hygienic advice.

Most of the textbooks of surgery of the time contain a chapter bearing
the title “De Hecoratione,” where cosmetic and hygienic matters are dis-
cussed.

With the Renaissance came a great revival of Greek ideals, a new so-
ciety developed, the moral ideal of which tvas humanity, and this meant
the highest possible development of man among his fellow creatures, the
highest possible development of personality. Greek art, Greek institu-
tions rvere eagerly studied, and one endeavored to live the life of the
Greeks again. We should expect that such an attitude would have led to
a revival of Greek hygiene, and yet that tvas not the case. Why? Because
the educational ideal of the Renaissance, though an ancient ideal, to be
sure, was not the Platonic ideal of harmonious man, but the ideal of
Quintilian, the ideal of the homo Ciceronianus. It was a one-sided ideal,
tending to develop the mental quality of man and his rhetorical abilities.
And so hygienic conditions were very bad still and remained bad for cen-
turies. The mortality, especially among children, was appalling. The
plague never quite disappeared, and terrific epidemics of smallpox, diph-
theria, tuberculosis, measles, typhus, and typhoid caused great devasta-
tion. In the seventeenth century the first vital statistics were made, and,
imperfect as they were, they attracted public attention to the terrific
death rate. People tvere afraid; one felt that the ivhole population ivas
threatened and that something had to be done. During the eighteenth
century, hygiene was greatly improved, and these improvements ^vere
due not so much to the medical as to the political conditions and to the
philosophy of the time. In the absolutistic government, the monarch feels
responsible for his subjects. He is to his people just rvhat the father is to
the children. He orders what is to be done in order to be healthy, and he
forbids what could do harm. Health is enforced by means of the police.

It is not by accident that Johann Peter Frank called his famous book A
Complete System of Medical Police. Frank is the chief representative of
this absolutist trend. His ideal is a system of policing with a book of laws
which would prescribe for people what they have to do in order to be
healthy from the time of their birth until their death. According to
Frank, the most intimate processes in human life should be regulated by

ON THE HISTORY OF MEDICINE

police laws This was a mode o£ hygiene which might be defined as ‘ hy
giene from above

But at the same time a new trend is noticeable with the awakening
which gripped the masses during the eighteenth century In 1762, Jean
Jacques Rousseau s Contrat Social appeared It is in strong opposition to
the concept of absolutistic government Rousseau thought that all men are
good by nature, that they are ruled from above with tyranny and comip-
tion The people are unhappy because they are not enlightened they are
ill because they are ignorant They must be enlightened about everything
that concerns health and disease From above nothing of good can come
to the people, they must help themselves and they can do it because they
are reasonable Thus a hygiene from below ’ starts in A tremendous
mass of literature appears a great many periodicals are founded, designed
to teach the common people method of hygiene These are theories
which finally led to the French Revolution
The same trend can be observed in this country, where the philan
thropists first of all Benjamin Franklin and Benjamin Rush devoted
much work to improving the health of the common people The most
famous health catechism of the time, written by a German physician
Bernhard Christoph Faust, in 1794, was translated into English and
adapted to American conditions at the instigation of Benjamin Rush
and Dr Woodward of North Carolina Four years after, the initial ap-
pearance of the book in the American edition was made in New York
About the same time the child was discovered and so we find a strong
movement toward child welfare The child must be liberated too it had
been left to the care of nurses and tutors who had no understanding of
Its needs Problems of education were hotly contested The philanthro-
pist endeavored to detach education from religion at least from the posi
tive religion which was to be replaced by a natural theology And then
the century closed with the great discovery of vaccination
After the French Revolution there was a reaction not only in the
political realm but in hygiene as well In the eighteenth century every
body was interested in problems of hygiene and common welfare In the
beginning of the nineteenth century, the bourgeois became rich and was
not much interested in his fellow men But at that time a new revolution
beame manifest, the Industrial Revolution New machines greatly modi
fied die IS hole structure of society, the population increased tremen
dously, and great masses of the people lived under most miserable condi
Uons A new class rvas formed, the industrial proletariat, among whom

THE PHILOSOPHY OF HYGIENE

hygienic conditions were frightful. Tlie people felt themselves threatened
again, and, when cholera invaded the world in the thirties, the general
public conscience experienced a very brutal awakening. The bourgeois
came to recognize that bad health conditions threatened his life also, so
that in 1 843 a commission was established in England to study the sanitary
conditions of the country, and this led finally to the Public Health Act
in 1848.

The new hygienic movement started in England. In other countries,
there was much theorizing about lij-giene. A great many books were
svritten, and theoretical advice was liberally dispensed. England took the
lead in practical applications, and so the question naturally arises why it
svas just England that became the center of hygienic endeavor in the
middle of the last century. The reasons are obvious. Hygiene presupposes
a definite ideal of healthy man. While on the European continent the edu-
cational ideal rvas a one-sided mental one, in England it was humanistic in
the true sense of the word. It was the old Greek ideal of the well-balanced
man mentally and bodily Itarmonious. Sport tvas an integral component
of education in England, and where sport is pursued seriously important
conditions for personal hygiene are obtained. Public health, on the other
hand, demands a government which in itself is strong. Germany was
broken up into little states, France and Italy went from one revolution
to another, and England, like the Roman Empire of old, was a country
existing under the best conditions.

From England the new hygienic movement spread all over the world.
The great biological discoveries, so well described by Dr. "Welch in his
address, afforded new methods which made it possible to combat disease
more and more efficiently, and all this led to the development in which
we are still active, and in which your institute plays such an important
part. And yet I must repeat that medicine alone will never be able to
fight disease successfully. This is illustrated in a particularly graphic way
by the work done in this country for the prevention of tubercuiosis and
venereal diseases. While the campaign against tuberculosis started at the
beginning of this century has been utterly successful, the prevention of
venereal diseases has been a failure so far. The reasons are easy to trace.
They are not in the field of medicine, for we know the nature of both
diseases well, and tiie treatment for syphilis is probably easier than that
of tuberculosis. The reason here again lies in the cultural background.
Tuberculosis is considered by the population to be a disgrace; syphilis,
however, is a sin. The venereal diseases are still covered by a veil which

ON THE HISTORY OF MEDICINE

makes it very difficult to fight them openly In order to be successful,
therefore, a campaign must start by changing the whole attitude of the
population towards the disease

From ivhate\ er angle we approach these problems, over and over tve
find that hygiene and public health, like medicine at large, are but an
aspect of the general civilization of the time, and are largely determined
by the cultural conditions of that time

THE SOCIAL HISTORY
OF MEDICINE

JL WOULD like to draw your attention to a field of studies in the his-
tory of medicine that has been greatly neglected in the past. If you open a
textbook, any textbook of medical history, and try to find what health
conditions were in rural France in the eighteenth century, or what dis-
ease meant to the family of an artisan at the same period, you will as a
rule not find any information. We know much about the history of the
great medical discoveries but very little on whether they were applied
or to svhom they were applied. The great achievements of the French
clinic in the early nineteenth century are described in detail, but we do
not hear that in the same period health conditions were atrocious among
the industrial population of France. Fora long time the biobibliograph-
ical approach was most popular in medical historiography, and the
narrative boiled dotvn to the history of the great doctors and of the books
they uTOte. The biographical approach ^vas so popular because it has a
strong human element and lends itself to dramatization. History thus
appeared as the free play of men of genius tvho made their discoveries,
being possessed by a desire to find the truth. Great interest was being
shown in "firsts.” Who was the first man to see a condition; who the
first to perform a given operation? I have found in my studies that many
great discoveries svere made simultaneously by various people. Potential
men of genius are present at all times. Circumstances very often deter-
mine whether they may come to the fore and to ^vhat subject they may

Read before a meeting of the CaliloToia Aeademf of Medicine in 5aa Trsnaseo, March
11. 1940.

ON THE HISTORY OF MEDICINE

apply their genius Pasteur was a diemist and considered it his chief
task to elucidate the secret of life by studying the structure of matter
External circumstances drove him into the field of pathology, where he
made his most important contributions

I have shocked medical audiences more than once by saying that medi
cine IS not so much a natural as a social science The goal of medicine is
social It IS not only the cure of disease, the restoration of an organism
The goal is to keep man adjusted to his environment as a useful member
of society or to readjust him as the case may be In order to do this, medi
cine constantly applies methods of science, but the ultimate goal is social
nevertheless In every medical action there are always two parties in
volved the physician and the patient, or, in a broader sense, the medical
corps and society Medicine is nothing else than the manifold relations
between these two groups The history of medicine, therefore, cannot
limit Itself to the history of the science, institutions, and characters of
medicine, but must include the history of the patient in society, that of
the physician, and the history of the relations between physician and
patient History thus becomes social history, and I hope to be able to
show you that such an approach is promising and can contribute to a
better understanding of social problems of medicine that we are facing
today

The position of the sick man in society has changed a great deal in the
course of time There are still a few primitive tribes among which a man
suffering from a serious disease is abandoned Society is afraid of him,
as It IS of the dead, and flees from him so that he is dead socially before
physical death has overcome him In tribes of higher civilization the sick
man is considered the victim of evil forces Witchcraft, the action of evil
spirits, or the wrath of a deity may be responsible for his illness In the
Semitic civilizations we find a different view The patient is a victim to
be sure, but he suffers in atonement for sm All suffering is inflicted as
punishment for a sm committed by the man himself, by his parents or
by his clan The sick man is branded with the odium of sinfulness, this
ancient \iew survived the centuries and millennia In the Middle Ages
epi emics an other natural catastrophes were frequently considered
God "P"" ">'='■ The days .re not far remote
when people believed that mental diseases were the result of a disor

the social HlffTORY OF MEDICINE

dinate life, or that venereal diseases were the logical punishmept for
sexual promiscuity.

The position of the sick man was different again in Greek antiquity.
The Greek world was a tvorld of the healthy and sound. The ideal man
was the harmonious being, perfectly balanced mentally and bodily.
Health was considered one of the highest goods, and disease a great curse
because it removed man from the condition of perfection. To attend a
hopeless case was regarded as unethical since the end in view, the com-
plete restoration of the patient, was unattainable. Weaklings and crip-
pled children were destroyed. The sick man was an inferior being, and
this too made his position particularly hard to bear.

Christianity gave the sick man a position in society that he had never
had before, a preferential position. The new religion addressed itself to
the poor, the oppressed, the sinners, and the sick. It addressed itself to
suffering humanity and promised healing and redemption. All other an-
cient cults were for the clean and pure, excluding individuals that had
become impure. Christianity relieved the sick man from the burden he
had carried before. He was no longer considered an inferior being or one
who was punished for sin. In suffering, man was carrying the cross of
Christ and would be rewarded in the hereafter. It was made the duty of
man to attend a sick fellow man. By joining the Christian community an
individual became a member of a family, and, just as the family was re-
sponsible for the sick children, so was the Christian family for the sick
brothers. When Christianity became the official religion of the Roman
Empire, society as such became responsible for the care of the sick.

Since the beginning of our era, the sick man has retained his preferen-
tial position in society. To attend him in his distress was a charitable
duty during the Middle Ages. It is more today. IVe know that if large
sections of the population are sick this represents a menace to the whole
of society. It is a matter of medical common sense to provide care for the
indigent sick and to prevent serious illness and epidemics. More and
more we have accepted the viesv that man has a right to health or, more
correctly, a right to have all means that medical science can provide made
available to him for the protection or restoration of his health. This right
was justified by a German physician, S, Neumann, in 1847, who declared
that the state was pledged to protect the people’s property and that the
only property of a poor man was his labor power, which is entirely de-
pendent upon his health. We need not look for such a justification in a
state the constitution of which guarantees life, liberty, and the pursuit

ON THE HISTORY OF MEDICINE

o£ happiness If the state is to protect these nghts as inalienable and if it
IS bound to promote the general welfare of the people, it seems fairly
obvious that health must be a primary concern of government

The physician of primitive soaety was a physician, priest, and sorcerer
all in one He knew how to placate the deities, how to ivard off ivitch
craft, and was experienced m the application of herbs Shamanism was
hereditary in certain tribes, while in others young people tvho had had
an unusual infancy seemed to be predestined for their mission It was
the shaman or medicine man s function to consult the oracles in order
to know the nature of a man’s disease and to be able to cure it

With developing civilization the threefold functions of the primitive
medicine man were split up At all times there were patients who sought
healing not from medicine but from religion Every civilization devel
oped definite forms of religious medicine, healing cults It ivas in ancient
Greece the cult of Asklepios in whose temples miracle cures were per
formed In the Roman period his cult tvas so popular that other gods
entered into competition with him and patients flocked to temples for
healing all over the ancient world In the early Christian church pa
tients were treated with prayers In the Middle Ages menial patients were
believed to be possessed by evil spirits, and incantations and exorcism
seemed the logical treatment To our days, the Catholic church and Prot
estant sects have practiced faith healing, so that religious medicine actu
ally survived through the ages

The belief in magic and witchcraft has also had a long history What
was considered a legitimate science once was called a superstition later,
but consciously or not people still wear amulets, still perform definite
gestures to counteract the influence of evil signs It is not so long since
ivomen isere persecuted as witches

he rational empirical component of primitive medicine developed
It growing civilization into a system of medicine which excluded the
transcendental and was based on observation and reason The Hippo-
no longer a priest and anything but a sorcerer He
tsman and was trained as such He entered the services of a
apprentice, accompanied him to the bedside of patients
dointr drugs and performing operations, and while

domg .h« h. learned to observe the symptoms o£ duLe, learned how to

THE SOCIAL HISTORY OF MEDICINE

e\*aluate them in order to know what fate had in store for the patient,
and learned treatments and cures. ‘When he had become a master himself,
he practiced independently and did it usually as an itinerant physician.
Only larger cities had permanent docton; when a to^vn wished to secure
for itself the ser\’ices of a doctor, it offered him a salary raised through
taxation in order to induce him to settle dotrn. He ivas allowed to charge
fees for his treatments, but was guaranteed a minimum income. All
smaller places, hotvever, were sen-ed by doctors who came one morning
knocking at the dooK offering their services, just as other craftsmen did.
If there were enough sick people in the place, the doctor rented a shop,
the iatreion; when patients were brought to him, he examined and
treated them, moving on to the next town when work gave out. If two
physicians entered the same city at the same time, a wild competition
resulted. In a society that did not license physicians society had no guar-
antee as to the knowledge of a medical man. Anybody could call himself
a doctor and treat patients for fees. A physician rvas legitimatized by his
reputation. This is why so much emphasis was laid upon doxa, reputa-
tion, in ancient medical ethics. Reputation was the goal of the Hippo-
cratic oath~“and if I hold this oath and break it not, may I gain reputa-
tion among all men.” Like other craftsmen, Uje Creek physician sold his
services for money. He sold them to whomever could purchase them, and
those who had no money had no medical care, a condition that was gener-
ally accepted.

Things changed rvith the advent of Christianity. The view became
general that everybody should be attended, whether rich or poor, and
should have all the care that medical science -tvas able to give. In the early
Middle Ages most physicians were clerics. They were supported by the
church and could practice medicine as a charitable service. Even in the
later Middle Ages after many laymen had entered the profession condi-
tions remained very much the same. Many doctors still had stipends from
the church making them economically independent, others had salaried
positions in the service of cities as municipal doctors, and still others were
attached as body-physicians to the court of some nobleman, lay or eccle-
siastical. Those who had a private practice had to follow rigid standards
established by the medical faculties which acted as the physicians’ guild.
There tvas no, or very little, competition. The medieval ^vorld ivas a
static svorld in which everyone ivas bom to a definite status and where all
aspects of life were regulated by authoritative bodies.

Conditions changed again in the sixteenth century when a new eco-

ON THE HISTORY OF MEDICINE

out a license Pharmacies were under strict state control Frederick II
and the school of Salerno set an example that ivas later followed by other
European countries

The state not only protects society by requiring a definite amount ot
knowledge from its physicians but also through a number of regulations
that are found m the penal codes of most countries The patient s se
crets are protected by law, and the physician is made liable for his actions
He can be prosecuted if he harms his patients, which is why physicians
have to carry malpractice insurance

Society not only set standards for the physician’s behavior but took
over medical functions Many medical tasks were found to be of such
magnitude that they could not be carried out by individual physicians
but required the state power Early in antiquity the sanitation of dwell
ing places and the protection of groups against epidemic diseases became
administrative functions of the state Throughout the Middle Ages pub
lie health was an important function of municipal administrations, and
with the progress of medicine the field of public healdi broadened con
siderably Whenever private medicine was unable to solve a problem,
public services had to step in This was the case m the care of tubercu
lous and mental patients, of indigents in public hospitals, in recent
years the fight against infant and maternal mortality and venereal dis
eases has become to a large extent a public function In every country a
great volume of medical work is carried out by state agencies

The scope of medicine broadened from century to century The physi
cian today is the psychological adviser of the educator, and mental hy
gicne is beginning to play an increasingly important part The physician
IS also scientific and psychological adviser to the court, without whose
cooperation the administration of justice would not be possible He has
to determine the cause of death He has to advise the judge as to the re
sponsibihty of a criminal, and psychiatrists are consulted more and more
frequently m determining a sentence that will not merely punish but
rehabilitate a criminal

Economic developments greatly influenced medicine The rise of m
dustry from the end of the eighteenth century on created a whole set of
new medical problems The workers had to be protected against new
health hazards All civilized countries enacted workmen s compensation
aws which guarantee treatment and compensation to the victim of m
dustnai accidents and diseases, and thus force the employer to take
measures m order to reduce health hazards While industry developed.

THE SOCIAL HISTORY OF MEDICINE

medicine progressed. Many Imman lives can be saved today that were
irrevocably lost only fifty years ago. The progress of medicine, however,
increased its cost to such an extent that large sections of the population
are unable to purchase the medical services they need. A paradoxical
situation has developed. "We have the means of wiping out a great many
diseases ivhich, hotvever, are still among us because tve are not able to
apply our scientific knowledge to all the people who need treatment.

While medicine progressed as a result of the great scientific develop-
ment of the nineteenth century, the structure of society underwent basic
clianges following tlie Industrial Revolution. A hundred years ago in this
country— and this applies to all industrial countries— one out of five gain-
fully employed persons was a svage earner, svhile today four out of five
are wage earners or salaried employees. 'Where the majority of people
depend for an income on the labor market and can be thrown out of a
job by its every fluctuation, there is by necessity a strong feeling of inse-
curity and, as a result, a strong demand for schemes that will guarantee
the people a certain amount of social security.

The situation became acute long ago, and in the nineteenth century
already ways and means were sought to bring medical care to people of
low income on another than a charity basis. In Russia, as early as 1864,
a complete system of state medical services financed through taxation tvas
established in the rural districts. In Germany, compulsory health insur-
ance was introduced in 1883 and was adopted by one European country
after another, and in recent years by four American republics.

Society also became inaeasingly axvare of the economic burden of ill-
ness. Health conditions have improved tremendously but we have the
knowledge enabling us to improve them still more, "We still have in every
country countless cases of unnecessary illness and many premature
deaths. Social planning is necessary in the medical field just as much as
in other human activities.

The problem is world svide. Even this very sketchy analysis will have
convinced you that conditions have changed. The society in which we
live is different from that of our ancestors. The physician is no longer a
medicine man nor a craftsman nor a priest. He has new tasks, new func-
tions, and new w’eapons. A nesv medical science serving a new type of
society necessarily requires new forms of medical service.

I think that the sociological approach to the history of medicine not
only gives us a better understanding of the past but can also help us in
planning for the future.

DEVELOPMENTS AND TRENDS
IN GYNECOLOGY

I SHALL not attempt m a short address to cover the history of gyne
cology It would be a futile endeavor, and besides 1 am sure that you are
all familiar with the highlights of the history of your science and art
My task will be different Taking g;ynecology as my subject, I would like
to make a feiv general historical remarks and would like to show you that
there are two aspects of the history of medicine Unless we consider them
both, we shall never attain to a comprehensive picture of developments
Tliere are actually two histones of medicine One is the history of medi
cal science It teaches how man gradually discovered the structure of the
human body, the function of its organs disease mechanisms methods to
diagnose disease conditions to evaluate them in making a prognosis, and
finally methods of treatment The more knowledge man had, the more
effective his weapons became in the prevention and cure of illness This,
hmsever is only one side of the picture, and there is another aspect to it
the social and cultural history of medicine Knowledge alone is not
enough It does not become effective unless we are able to apply it So
ciety must be ready to accept the physician s advice and here we find
that religious and philosophic vicivs social and economic conditions had
a tremendous influence and largely determined success or failure of med
icine

SoS^r IMl Cp..colos.c=.I

DEVELOPMENTS IN GYNECOLOGY

^ There is another point that must be taken into consideration. Scien-
tific research was applied to subjects that seemed important at the time.
Valuations changed a great deal and were also determined by nonmedi-
cal factors. Modem pediatrics could not develop before chemistry had
reached a certain level, but it could not develop either before it had
been recognized that the child is more than a small-sized adult, and be-
fore the position of the child in society had changed. This likewise was
the case with gynecology. The attitude of society totvard woman and her
position in the social structure were just as important factors in the his-
tory of gynecology as medical science. I would like to illustrate this by
going with you rapidly through the various periods of history.

A determining point in the history of gynecology is to be found in the
fact that sex plays a more important part in the life of svoman than in
that of man, and that she is more banJened by her sex. Nature has im-
posed menstruation upon her, the long period of pregnancy, the pains
of childbirth, and the period of nursing. This explains two basic atti-
tudes. "Woman is periodically weakened by her sex life and in need of
protection. She becomes dependent on somebody else, and this opens the
door to exploitation. The history of exploitation of woman by man is
endless. ^Vhoever has traveled in the eastern Mediterranean countries
remembers the familiar sight of a woman marching with heavy loads on
her head and arms, (allowed by her husband and lord riding comfortably
on a donkey and smoking a cigarette. Even in our ovm society we dis-
criminate constantly against women, paying them lower ivages than men
for equal work. We discriminate against married teachers and against
women students and physicians even in our otvm medical schools and
hospitals.

On the other hand, woman by giving birth to life became an object
of worship. She is fertile like the soil. It was knosvn that seed svas needed
for the plant to grmv, but svberever Ihe soil was fertile vegetation was
found. The mystery of creation takes place in tvoman as it does in nature.
Nature svas ivorshiped, and so ivas ivoman. The Great Mother %vas a
deity found in the earliest civilizations. Neolithic statuettes have been
excavated representing a svoman that consists of nothing but sex, and
there can be hardly any doubt that they represent a deity. In some tribes
the dead were buried with their heads covered with cowry shells. The
shells were the symbol of the female genital organs, of the door to life.
The shell caps were meant to help the dead in coming back to life again.
This function of woman as the creator of life gave her prestige, and

ON THE HISTORY OF MEDICINE

poiver at times, ivhich explains why matriarchy ivas the social organiza-
tion of many early tribes

The fertility of man was rarely questioned, and even today when a
family has no children the wife is suspected first, and it is difficult to
convince a husband that he may be responsible for the condition
The fact that the mystery of creation takes place in woman led to the
view that the womb must be an organ of a special kind The uterus was
frequently viewed as a living organism of its own, endowed with inde
pendent motions with desires and whims One of our oldest medical
documents the gynecologic papyrus of Kahun written in the third mil
lennium b c , describes the uterus as being irritated or sluggish or wan
dering to places where it does not belong All these conditions were con
sidered to be causes of disease The word hysteria that we still use means
nothing else but the disease of the hystera, which is the Greek word for
uterus In a medieval incantation that I found in a tenth century manu
script the exorcising priest addresses himself to the uterus, conjuring it
to remain in the place destined for it by God and not to wander through
the human body causing disease In votive offerings the womb was fre
quenily represented as an animal chiefly as a toad Even in rational
therapy certain procedures such as fumigations with odoriferous drugs
were meant to please' the organ

Because sex played such an important part m woman’s life, and be-
cause new life came from her, more taboos were imposed upon her than
upon man In all ancient cults woman ivas considered unclean during her
periods, during childbirth, and in childbed As long as she ivas unclean,
she ivas not permuted to enter the temple, and her condition was con
sidered contagious until she had undergone purification This gave her
an isolated position in society The concept of cleanliness ivas purely
spiritual, but it had Iqgienic consequences in that it protected woman
against sexual intercourse during menstruation and during the period of
in\oUuion These old mciss, familiar to us from Leviticus, are still alive
not only among Jcus but in the whole Mohammedan world I Iieard in
Bosnia that women there are not allowed to give birth to children in the
house, since this svould make it impure Tliey go to the stables where the
child IS bom bciuccn a cow and a goat, and infccuons result quite fre-
quently ^

Childbirth was considered a physiologic process and was therefore not
an object of metlicmc In pnmuise soaeiy a woman, when her hour had
come, went into the bushes or to the river and came back after a while

DEVELOPMENTS IN GYNECOLOGY

ivitli the newborn infant. If help was needed, it was given by a fellow
w’oman who had gone through this experience herself and therefore knew
about it. This still happens today all over the world. And when women
began to give this aid professionally they became midu'ives. The institu-
tion of midwifery has playctl an extraordinarily important part in the
history of medicine. Until a few centuries ago, the midwife sv'as the gyne-
cologist and obstetrician of society. She had empirically acquired knowl-
edge and skills and in addition was ilie confidante of women. She, and
not the physician, svas consulted by women in all matters of sex.

Having been trained in Europe where the institution of midwifery is
still firmly established. I have a high respect for the svork of these sv'omen.
I have seen them in action in mountain villages of the Caucasus and
among African tribes. As long as society cannot provide a trained obstetri-
cian for cveiy ivoman, the mldwlfestlll has an important part to play, and
there arc conditions where she can acliicvc more than the physician. She
has more time to spend with the woman in labor, and is frequently closer
to the people, one of them, speaking their own language and familiar
with their customs,

lYe do not know svhen g^Ticcolog>' became a part of medicine. No date
can be set for it. As soon as man began to obscr\'e 5>'mpioms of disease
and to reason about them, he sasv that women were suffering from pains
peculiar to them, from fluxes, discharges, and swellings, that their periods
svere irregular and that childbittli was not ahvays a physiologic process.
Egyptian papyri and Babylonian cuneiform tablets all mention gyne-
cologic s>'mptoms and treatments. Magic took a relatively important part
in this field of medicine. Amulets svcrc worn. No Egyptian svoman would
enter labor sviiliout having a statuette of the hippopotamus-shaped god-
dess Thocris near by. Amulets are still worn by women in childbirtli
today. The old idea that in sudi moments people are the easy target of
evil spirits still persists. From Herodotus we know that Egyptian medi-
cine at his time ivas highly specialized, that there were specialists for
every organ and every disease. We do not hear of specialists for the female
organs, for Uie good reason that these organs and the diseases of tvomen
were the midwife’s domain. She was the specialist.

In ancient Greece the social position of tvoman varied a great deal
according to tribes. Among the Dorians of Sparta girls took an active part
in the physical exerdses of boys. They were trained to be mothers of
soldiers. Conditions were different among the lonians, where the girl
grew up in tlie Iiouse, was veiled in the streets, and was married by her

DE^^ELOPMENTS in G\'NEC0L0GY

Cliristinnity ^^■3% primarily inicrcitcd tn ilte health of the soul, and a great
deal of inicrpTctation vas required to justify care of the body and to
rcmncilc the nctv creed udth ancient science.

llic attitude toward woman was by no means favorable for the de-
velopment of g)riecology. I^fan and w'oman were declared equals before
Cod, spirimally, in the Ijcreaficr, bin oihenvisc woman was considered
an inferior being. Man svas made from earth, btit woman from man's rib.
Sin bad come into the world ihrouglt Eve- Her sin svai rcsponsiblefor the
pains of love and for the pains of childbinli. A cliurch fatltcr called
woman januo lUaholi, the door to hell.

These vtesN's also inflticncetl the attitude toward sex. The Greeks had
taken sexual intercourse for granted and had looked at it as a physiologic
process that was recommended sometimes for reasons of hygiene. Christi-
anity considered sexual intercounc sinful unless it was performed by mar-
rictl persons with the dcHnitc purpose of procreating children. Origenes
went to f.rr as to pottulatc that it should be performed dispassionately,
and tliai even then it should not take place in a room where people pray.
Tlic soitl counted, and saltation teas the purpose of life. Abortion was
considered murder of a patticularly vicious kind, because it prevented a
httman being from being b.sptirc<l. Faced svhh the alternative of saving
moUier or child, the physician was to sacrifice the mother without hesita-
tion since the mother uas already baptized and prepared for the hereafter,
while the unbapiircd child would be relegated to limbo. Contraception
ss-ascs en worse because it prevented the creation of a human being. Chris-
tianity set rigid tal)oos on sexual matters, under which ilic western world
had to suffer for a long time.

There ss*as woman svorsliip in the Middle Ages too. There was a cult of
Mary’, but ^fa^y s^-as a virgin who had conceived without sin. There was
a cult of woman in chivalry, but it was short-lived, had pagan elements,
and was limited to a small group. Throughout the Middle Ages woman
tvas relegated to the home and kept subservient to man.

Sucli conditions svere not favorable for the des’elopment of gynecology,
and hardly any progress was achieved during the period. Practices fol-
lowed traditional lines and consisted of ancient reminiscences. Gyne-
cology and obstetrics were in the hands of midwives. The Tnulieres Saler-
nxtanae were midwives, specialists in the treatment of womens ailments.
Literature consisted mostly of catechisms, from that of Mustio in the
sixth century a.d. to the Itosfngorten of Rbsslin in 1513.

A revolution was created in the Renaissance in this as in other cultural

ON THE HISTORY OF MEDICINE

fields A new world developed in western Europe which was very different
from the static world of the Middle Ages with its rigid regulations The
new Asorld appealed to the individual in man and called for free compe
tition and free initiative The attitude toward woman changed and
voices were heard calling for her liberation The great humanist Erasmus
of Rotterdam in one of his CoUoqutes has a woman say Men are tyrants
They use us as toys They make us their laundresses and cooks
and take care to exclude us from all other functions Let them keep for
thcrasches the tasks of government and war but the mother should at
least have a vote when it comes to establishing her children Another
humanist Cornelius Agrippa m a Latin Disqiitsttion on the NobiUty
and Preexcellence of the Female Sex, published m Antwerp in 1529
went even further when he said Acting against all divine law violating
with impunity natural justice the tyranny of man has deprived woman
of the liberty with which she was endowed at birth As a child she is
kept idle in the home As if she were unable to attend to any higher func
tion she is not permitted to touch anything but needle and thread Vet
she has a claim to rights Her part in the bearing of children is much
more important than that of man She nourishes those fragile little crea
tures and attends to their development And is she not just as intelligent
as the other sex? Slie has even more insight and acuteness of spirit
Guided by an instinct which is a privilege of her nature she often sees
things more correctly than plulosophen and scholan
^Vitli this scientific and social background gynecology could not but
progress In the sixteenth century the foundation of a new descriptive
s^sicmitic hiim'in anatomy was liid All tlic anatomists of the lime studied
tlic female organs Leonardos drawings of the child m vtero were the
first to break a long tradition of diagrimmatic pictures that illustnted
catecliisms from Musiio on Vcsalius observed that the pelvic bones do
not separitc in childbirth Fallopio described the tubes Aranzio ob-
scrvetl deformities of the pelvis

On the basis of this new anatomy a new surgery was bom and this
^mediately benefited obstetrics and gynecology In France Ambroisc
Vixi became not only the hther of surgery but was also greatly intcrestet!
in obstetrics and called himself not only a surgeon but also an accoucheur
He and his disciple GuiUemeau pncticcd podahe versions inducctl pre-
mature labor in cases of Iicmorrhagc and sutured the perineum Cesar
«n wiion had been practiced on the dead for centuries ever since an
Oman w had prescribed that no pregnant woman might be biincd

developments in gynecology

,vhhcu. having .he child icmovcd. Bu, rb^bt^e

hut they were pledged ? ; a„d their profestion was regulated

Many were in the servace ot the c . d j„ j,;

:^;^L?^niuT.l.“;of Ratisbun estabiished oid age and disability

\\Tiilc Drtcartes inaugurated a pen flourished, CampanelU ^sta

mation was launclied. religious J" ® I the same time,

tortured, and Giordano Bruno humrf a. the ^

when absolutitlic government P'''^ ^ England and Holland. In

oI other countries, democmq- develop m En„^^ ^

France women beeame more „.jo.e hU femmes

higher cdiiation. It n-at t '' .j.|^ j 3 ,„n flourished in France,

Smunles and his Their discoveries before an audf

where scientists were invited to P"« j , 3 ^^. MaUiematio were

ence of men and women It Wml. Leibniu. and

highly cultivated, and the ^^.ieved in diis held. In phya.es,

Newton remind us of the P”' P ” „ere in the foreground. Prac-

dynamics and particularly ,hese studies. Waterways were

tical necessities forced nuniey^from Constantinople to \ emre

the chief highwaya of tiaflic. Th j 1 ^ nvo-wheelrf

vms Uiree times longer by '“"f J „[ goods, the avemge-sired
oacart could not All fliese .re^Beced themselves

ship transported more .hart eOO to^ At. u.

in medicine and in gynecology =■'“• amtomh anmeta, dy-

In the seventeenth century. a new phyaiology. but he w

mmic .n,,™,. Killi=™ t.ra. ol di™™^

in 1G72. In 1677 the spermatozoa wer

ON THE HISTORY OF MEDICINE

France had its great century, the Sifecle de Louis XIV, and the leading
gynecologist was Mauriceau, whose textbook, first published in 1668. was
used all over Europe

Holland had at that time its great period of expansion and coloniza
tion More than any other country it developed its ivatenvays Henrik
van Deventer was a goldsmith who became a physician, being interested
in mechanical problems, he entered the field of orthopedics His tvife
was a midwife, and he became interested in the architecture and me
chanics of the pelvis, a subject to which he made important contnbu
tions It IS not astonishing that this mechanical age produced the most
important tool in obstetrics, the forceps Invented by a barber surgeon,
Chamberlen, it was kept a family secret, was discovered independently by
Jean Palfyn and was approved by the Pans Academy m 1723
The education of midwives ivas improved In 1630 they were given
regular courses in France at the H6tel Dieu In Germany they were in
stnicted by the municipal surgeons Great names appear among the mid
wives of the period, such as Louise Bourgeois, Marguerite du Tertre, and
Justine Siegemundm They were skilled obstetricians, and their books
were widely read

In the eighteenth century pathology became anatomic From Vesalius
on, pathologic changes had been observed m organs, and such findings
were collected by Thiophile Bonet in his Sepulchretum of 1679 It was
Morgagni however, who in 1761 laid the foundation of modem patho
logic anatomy and created the method of pathologic research that was to
be followed from then on In the third volume of his De Sedtbus el
Cau5ii Morborum he discussed pathologic changes of the female genital
organs In the following years many dissertations were written on such
subjects, and the method of Morgagni was continued by Bichat and
Virchow, who traced anatomic changes in the tissues and in the cells On
the basis of these studies the various gynecologic diseases could be sharply
defined, and most disease entities that we recognize today were estab
lished during the nineteenth century in pursuit of this trend

As soon as pathologic anatomy ivas established a neiv task was set for
clinical diagnostic Its purpose became to recognize anatomic changes on
the living organism with physical methods This is why percussion and
auscultation were introduced at that time and became chief methods of
physical diagnostic It was Lejumeau de Kergaradec who had the bril
ham idea of applying Laennec’s auscultation to watch the heartbeat of
the fetus

DE\^LOPMENTS IN GYNECOLOGY

The eighteenth century an international century. Every country
made its contribution to g>'ncco!ogy. In England 'William Smellie and
IVilJiam Httnecr produced their superb atlases of the pregnant uterus.
Special lying-in hospitals were erected in every country. They not only
improved the conditions of women in childbirth, but improved also the
educational facilities for midwives.

In the nineteenth century therapy became anatomic, and this explains
the tremendous development of surgery. General anesthesia, antisepsis,
and asepsis broke the age-old bonds that had impeded the progress of
surgery. Anesthesia and asepsis were found because medicine had reached
the point at which surgery tvas no longer the uUimum refugium to svhich
resort As’as taken when all other mctliods had failed, but had become a
primary goal. Surgery revolutionired g)'necology and obstetrics. Major
abdominal operations could be performed now. Large tumors could be
removed without danger to the patient, and cesarean section svas no
longer an act of desperation. The development of surgery also aeated a
new type of hospital, and the number of deliveries that took place in
hospitals increased considerably. In this great development American
surgeons have played a ver)' important part, and I need only remind you
of the names of Ephraim ^fcDoweU and James Nfarion Sims.

Today a cj'clc has come to an end. Tire anatomic approach inaugurated
in the Renaissance has been applied to one medical field after another,
and today we are in a physiologic era. Physiology is in the foreground of
all considerations. We no longer operate for a retroflexion merely because
the uterus docs not hold the position prescribed for it by the textbooks.
Function is being considered first of all. New physiologic discoveries,
particularly that of hormones and vitamins, have stimulated both gyne-
cology and obstetrics.

I cannot discuss the recent developments, and I need not do it because
the gymecology that you practice today Tepresenls the experience of the
last fifty years. I would like to draw your attention, however, to the social
history of the period, an aspect that has been frequently underestimated.

The Industrial Revolution was the event that had the most profound
influence on the entire nineteenth century and on our days too. In-
dustrialization created employment not only for men but also for rvomen
and children. Women entered the process of production in increasing
numbers. The textile industries were built up almost entirely with
woman labor, but rvomen rvorked also in mines underground and in
other industries until factory legislation stopped some of the worst

ON THE HISTORY OF MEDICINE

abuses. As a result, health conditions deteriorated, particularly among
women. The population increased, especially the indigent population
that lived crowded in slums, in the suburbs o£ cities, under atrocious
hygienic conditions. We often forget that, at the time when the French
clinic flourished and modem medicine tvas making tremendous progress,
health conditions were exceedingly bad. The reports of Villermd in
France, of 1840, and of Chadwick in England, of 1842, speak an eloquent

language.

Industrialization had other results. Women were doing men’s work.
The development of industry would have been impossible without them.
It was nothing but justice that they should have been entitled to share not
only man’s labor but also his rights, that they should have had equal oppor-
tunities of education, and that the professions should be open to them.
It was felt that they should have a voice in the administration of the
commonwealth. A long struggle ensued against the vested interests of
men, a struggle that was not without dramatic episodes. \Vomen won
their case in most civilized countries, at least to a certain extent. Their
gains are now challenged in the Fascist countries.

This whole development had some definite bearing on gynecology.
Woman may have equal rights, and all occupations may be open to her.
Modem society needs her labor, but nevertheless she remains woman
and carries the additional burden of her sex. She creates commodities
and services, but she creates, in addition, our children. She is therefore

entitled to added protection. She cannot be considered free and equal as
long as pregnancy means loss of a job. If she is to be truly free and equal,
she must be guaranteed regular vacations on full pay and the rest she
needs during pregnan^ and after childbirth without loss of wages. Ma-
ternity homes, nurseries, and all other means for the protection and
restoration of health must be made easily available to her.

^ The strain of life in an industrial society weighs heavily on the work-
ing girl and woman, and maladjustments of some kind or another make
them seek the advice of a gynecologist. My colleague Sellheim in Leipzig
used to say that a woman's period is like a clock. Whenever something
goes wrong m that complicated mechanism, the clock immediately re-
vea s It y emg fast or sloiv or otherwise ivrong. Gynecologic complaints
drive a woman to the physician, but her ailment may not necessarily be
e TMu t o a gynecologic disease. A psychologic or social maladjustment
may e responsible for it. A gynecologist who would be nothing but a
surgeon would be utterly helpless in such a case.

DEVELOPAfENTS IN GYNECOLOGY

Gynecology, as the word indicates, is the science of ^voman in health
and disease, of her physiologic and pathologic processes and of all prob-
lems peculiar to her. This requires that the gynecologist be not only a
scientist but also have a broad psychologic and social approach to his
problems.

I have shown you that the gynecologist had two ancestors. The surgeon
was his father, the midwife his mother. From the father he inherited
techniques, knowledge, and skills; from the mother he received in addi-
tion the human touch. Like the midtvife of old, he must be the confidant
of women who consult him whenever they are in trouble, ^vhether their
ailments are organic or not.

In gynecology and obstetrics, as in every other field of medicine, the
urgent problem of our day is to make whatever knowledge we have avail-
able to all who need it. Great progress has been achieved, and many
human lives are being saved that would have been lost irrevocably only
yesterday. But we all know that conditions could be better than they are.
In spite of all progress, with all the knowledge and equipment we possess,
we still lose in this country annually about 9000 young mothers from the
results of pregnancy and childbirth, and we lose many of them need-
lessly, Every year more than 180,000 young women go through the trying
period of pregnancy and childbirth, and the result is a dead child or one
that will die during his first year of life. Our task is not yet solved. Science
and technology developed more than ever before. As a result medicine
progressed, the structure of society changed, and so did the position of
women in it. Conditions arc totally different today from tvhat they tvere
one hundred or only fifty years ago. It is obvious that adjustments must
be made.

You as individuals and as a group arc leaders in your field. Through
your researches you have advanced the science of gynecology consider-
ably. Your society was founded in 1876 and when you look back you can
be justly proud of your achievements, but you must remember that since
1876 the tvorld has changed a great deal. New social problems have be-
come very acute, and I am sure that in this field also the country is
looking to you for leadership.

HISTORICAL BACKGROUND OF
INDUSTRIAL AND
OCCUPATIONAL DISEASES

has tn riTYifiii ° mamtam his hfc He

to DTOduce S^thcf thc food that his organism requires and has

life easier and * ° himselE against the climate and to make his

hmnan civ?ui?°'^ The greatest advance in the h.stoi) of

Age from the fonH oITl Paleolithic to thc Neolithic

learned to cultivate^llanu" w°d'o''' '“ge. wh=n man had

Man struffclM t»i»i, ^ domesticate animals, to perfect his tools

his intelligence, invenuven«r‘* gradually through

and inammatc, active and nai’ ™‘* animate

cance to ^r.rit Lit n

tial values without which I.f, '"aterial and spirit

progressed, it was due to the cnr. ‘"'’‘"S “

hasa duty to work liii» 1, u ®^orts of all its members Man

Worh Llancestr 1* tdt "■

Yet sve all know that man t. ®ti essential factor of health

hinds of hazards svhich threamn h exposed to all

matter what the work was Th e** always been the case no

sng animals was subiect g^^^^nng his food hunt

fractures make this evident hJcohthic bones showing traces of

The Wesley M

C*T>snu,Le=,„„uel„e.^Oaot»iU, „„

INDUSTRIAL AND OCCUPATIONAL DISEASES

With developing civilization production increased. New occupations
created new hazards. The working conditions of a definite period and
country represent an important criterion of a given civilization. When
we look at the history of civilization from this point of viesv, we certainly
have no reason to be proud of our past.

We are inclined to value a civilization according to its artistic achieve-
ments. "We admire the p)Tamids and the temples of ancient Egypt which
have surv'ived the centuries and millenniums, but we forget that they
were built witli the blood and tears of thousands of human beings. Labor
in ancient civilization was primarily slave labor. The pyramids were
built by state slaves whose lives had no value whatever, whom every war
would replace. We still can see the Eg^’ptian workers laboring under the
whip as represented on wall paintings and in reliefs. The lot of the city
workers was hardly any better, and we can still perceive their voice of
rebellion. Egyptian literature has preserved, besides a huge mass of re-
ligious texts written in praise of the gods, a few scraps which tell us of the
hard life of the people.

I have never seen a blacksmith acting as ambassador or a foundry worker sent on
a mission, but what I have seen is the metal worker at his work: he is grilled at the
mouth of the furnace. The mason, exposed to all weathers and all risks, builds with-
out clothing. His arms are worn out with work, his food is mixed up with dirt and
rubbish: he bites his nails, for he has no other food. The barber breaks his arm to
fill his stomach. The weaver engaged in home work is worse off in the house than
the Women; doubled up with his knees drawn up to his stomach, he cannot breathe.
The laundryman on the quays Is the neighbour of crocodiles. The dyeworker stinks
of fish spawn: his eyes are tired, his hand works unceasingly and as he spends his
time in cutting up rags he has a horror of clothing.s

We admire the graceful Greek bronze sutuettes that fill our museums,
but we do not think of the copper miners providing material for these
Works of art, or the coal miners digging for coal to make the bronze, work-
ing ten hours in narrow galleries suffocated by heat and smoke. They

were prisoners of war or convicts as a rule.

The ancient physicians, keen observers as they were, noticed the influ-
ence of certain occupations on the workers health, A good deal of infor-
mation is scattered all over the Greek and Roman literature. A case of
lead poisoning iras correctly described by Hippocrates. Pliny of

the noxious influence of lead, mercury, and sulfur on those who handled

1 Papyrus Saljicr. 2, 4, 6, and following-

2 Epidemics VI. 23; cd. Uur6 V. 164-166.

ON THE HISTORY OF MEDICINE

tliese metals ® The poets Martial Juvenal Lucretius reflected the vie^vs
held by the layman and rvrote of the dangers of certain occupations of
the diseases of sulfur workers* and blacksmiths ® of the varicose veins of
the augurs® and the hard fate of the gold miners ’ But nothing was done
to protect the workers They had to help themselves as the minium re
fmers described by Pliny did who put membranes as a mask before their
faces * Medical care ^vas given to those who served to entertain the
people the gladiators Galen started his career by being physician to a
gladiator s school in Pergamon

Tlie ancient physicians were not actually interested m the health of the
manual laborers They devoted their attention almost exclusively to the
upper class It is quite characteristic that Celsus believes that medicine
onginated with the philosophers who having an unhealthy mode of
living naturally would be interested m correcting it ° The author of the
Hippocratic treatise Pen diaites gives special dietetic rules for such peo
pie who having some business to attend were not able to devote all their
time and all their attention to their health It would never have oc
cutred to him to prescribe any definite hygiene to craftsmen or workers

We must not forget however that ancient technology was mostly
small scale technology The artisans frequently worked m the open air,
as they still do in the Orient so that the hazards were infinitely less than
in later centuries after technology had assumed larger proportions

Ancient civilization created great cultural values but it was a culture
that was shared by only a small upper class and endless human lives had
to be sacrificed and a great deal of suffering had to be endured to allow
this culture to flourish

Hazards occurred not only in work but also in certain recreational
actiMtics Hippocratic surgery is mostly bone surgery and reflects tlie
experiences the surgeons had in the gymnasiums where dislocations frac
lures and odier injuries must have been quite frequent

‘Saturatllhiory^Xn 50 XXXIII 40
57 H

•Jmmal Salir«x 150
•Jmcnal S<ilir«VI 597
tLuemluj M 811

r=’ ■" ^

hiUnjt ihc duit which U hlchW bladder-sVln in order lo avoid In

.oad^h?! « ‘he ume i me .uiraeotly

•Cebui rrohocra 6 7 *

i«/-erfdi4{r«lll 68 0! UuxiM 5W

INDUSTRIAL AND OCCUPATIONAL DISEASES

The Middle Ages scarcely made any contributions to the subject, and
it is not before the end of the fifteenth century that we begin to find a
Special literature devoted to occupational diseases.

IVhy then? For various reasons. Medicine had progressed, and the phy-
sicians were keenly interested in describing new diseases. But there are
other, economic, reasons. The volume of trade had increased consider-
ably, which created a great demand for metals, particularly gold and
silver for currency as a medium of exchange. The voyages of discovery
were undertaken not so much in the interest of science as primarily in
search of precious metals. Besides, firearms were used more and more
frequently, which created a strong demand for iron, copper, and lead.
The shallow mineral deposits were exhausted and it ^vas necessary to dig
deeper, tvhich obviously created increased hazards. At the same time, in
many countries the farmers tvere evicted, were divorced from the means
of production, and became proletarians who had nothing to sell but their
labor powers. Many of them went into industry.

The morbi metallici were the first occupational diseases to attract the
attention of medical ^vriters. In H73 a German physician in Augsburg,
Ulrich Ellenbog, tvrote a little pamphlet of seven small printed pages,
Von den giffiigen besen Tempffen und Reuchen (On the Poisonous
Wicked Fumes and Smokes). Augsburg at that time was famous for its
goldsmiths. Ellenbog, svho apparently had such goldsmiths among his
patients, noticed that some of their troubles were probably due to their
working conditions. He wrote his pamphlet as a memorandum describ-
ing the dangers of fumes that developed from coal, nitric acid, lead, mer-
cury, and other metals. He advised the goldsmiths to ivork, whenever pos-
sible, in the open air, to cover their mouths when the fumes developed,
and, in the style of the time, recommended a number of drugs to be
smelled as a measure of protection. Ellenbog’s memorandum circulated
in manuscript copies in the svorkshops and ^vas printed in about 1524. It
must have been very popular because only one copy of the printed pam-
phlet is kno^vn to exist. It was, however, reproduced in facsimile in
1927.“

EUenbog’s ^vas just a short memorandum. The first monograph de-
voted to occupational diseases is due to Paracelsus, who, greatly interested
in chemistry, visited many mines, particularly those of Villach in K5m-

11 Ulrich Ellenbog. Ton dfn Tempgm und Reuehen, Etae gewcibe-

hygienische Schrift des XV. jahrhunderts, her»usgegeb«ra %on Franz Koelsch und Friedrich
ZoepB, Munich. 1927.

ON THE HISTORY OF MEDICINE

ten ivhere his father had settled to practice He lived and tvorked mth
the miners and got firsthand evidence of the appalling conditions under
which they ivere laboring and the very serious hazards to which they were
exposed

Paracelsus' monograph is a beginning Every svriter on mining after
that time neier failed to touch the diseases peculiar to this industry A
\ery good example of this type of literature is Agricolas work, De Rf
MelalUca,^^ published in 1556 In book VI he says
It remains for me to apeak of the ailments and accidents of miners and of the
methods by v,hich they can guard against these for we should always devote more
care to maintaining our health that we may freely perform our bodily functions
ilian to making profits Of the illnesses some affect the joints some the eyes an
finally some are fatal to men

He then goes on describing the various hazards that threatened the
miners, the abundant water often collecting in shafts making them cold
and in this ivay injuring the workers the dust that ‘ has corrosive quah
lies and cats away the lungs, and implants consumption in the body,
hence in the mines of the Carpathian Mountains women are found who
have married sc\cn husbands, all of whom this terrible consumption has
carried oft by a premature death * Stagnant air produces a difiiculty m
breathing The remedy is to be found in the ventilating machines Or the
ajr 1! infected SMih poison, causing swellings and paralysis Accidents
arc described as being not rare, workmen slipping from ladders m the
shafts, breaking ihcir arms, legs, or necks, or falling into the sumps and
being drowned Mountain slides occurred, as was the case in Rammels
berg SNhere in one day MOO women were robbed of their husbands’
Venomous anis were found in several mines And finally there was one
liazard that we no longer know * In some of our mines, though in very
few, there are pernicious pests These are demons of ferocious aspect
. . , demons of this kind arc expelled and put to flight by prayer and
failing ’

Special monographs on diseases of the miners were written by several
German physicians, the most important being Martin Pansa,^* Leonardos
Unmus »« Samuel Stockhausen,” Suchlandms ”

- ’*^^'*’‘** tniuUtnl from the Cnt UtJn edition of 1556 by

II Cll^»tmn.ll_|| lloom Ixmdon 1912.

mv .c/b-n 1652

»» f»e f i \o%la Mofb ,o , t6,«

l«ner# Limhi 1W5

INDUSTRIAL AND OCCUPATIONAL DISEASES

There is no doubt that mining was the most dangerous o£ all occupa-
tions and therefore was given attention first. In the seventeenth century,
books began to be written on the diseases of other occupational groups.
They concern less the working class than the upper class, the courtiers,
the scholars, men of letters in general, but then also soldiers and sailors
because the fighting strength of an army or navy was determined to quite
an extent by the health conditions.

A great many scattered observations on occupational diseases are found
in the medical literature of the seventeenth century. The century of
Sydenham was naturally interested in disease entities and endeavored to
describe their clinical picture accurately. But the seventeenth century
was also the century of the iatromechanists, who attempted to explain the
functions of the human body mechanically, who liked to compare the
organs to tools and therefore rvere interested in tools and machines.

And then in 1700 the Italian physician Bernardino Ramazrini pub-
lished his famous book De Mortis Ariiftcum Dtoiriba, of which an Eng-
lish translation appeared in 1705 under the title; A Treatise of the Dis-
eases of Tradesmen, Shewing the Various Influence of Particular Trades
upon the State of Health; with the Best Methods to Avoid or Correct It,
and Useful Hints Proper to Be Minded in Regulating the Cure of All
Diseases Incident to Tradesmen''’— the first textbook on occupational
diseases. I have just reread it. It is a fine book, a real medical classic. It is
to the history of occupational diseases what Vesalius’ book is to anatomy,
Harvey’s to physiology, Morgagni’s to pathology. It would be worth while
reprinting the complete English translation of the book as it is not only
interesting from the medical point of view but pves a very good account
of the working conditions of the time.^®

Ramazzini was a distinguished physician in Modena, professor at the
University of this city, and in 1700, the year his book was published, he
was called to the University of Padua. Discussing the diseases of "Cleans-
ers of Jakes” (chapter XIV), he tells us how he became interested in his
subject.

The Accident, from which I took occasion to write this Treatise of the Diseases of
Tradesmen is as follow’s. In this City, which is very populous for its Bigness, and
is built both close and high, it is usual to haw their Houses of Office cleansed every
third Year; and, while the Men employed in this Work were cleansing that at my

IT Further English editions uw published 1716 and 175a

J8 Abstracts have been reprinted by Herman Goodman, New York, 1953. The original
Latin text was reprinted with an inuodoctlon by F. C. Mayer (now at the Army Medial
Library in ^Vashington). in Budapest, 1928.

ON THE HISTORY OF MEDICINE

House I took notice of one of them who worked with a great deal of Anxiety and
Eagerness and being nio\ed with Compassion I asked the poor Fellow ^Vby he did
not work more calmly and avoid over tinng himself with too much Straining? Upon
this the poor ^Vretch lifted up his Eyes from the dismal Vault and replied That
none but those who have tried it could imagine the Trouble of staying above four
Hours in that Place it being equally troublesome as to be struck blind After he
came out of the Place I took a narrow View of his Eyes and found them very red
and dim upon which I asked him If they had any usual Remedy for that Disorder?
He replied their only Way was to tun immediately Home and confine themselves
for a Day to a dark Room and wash their Eyes now and then with warm Water by
which Means they used to find their Pam somewhat assuaged Then I asked him if
he felt any Heat in his Throat and Difficulty of Respiration or Head ach? And
whether the Smell affected their Nose or occasioned a Squeamishness? He answered
That he felt none of those Inconveniencies that the only Parts which suffered were
the Eyes and that if he continued longer at the same Work without Interruption
he should be blind in a short Time as it had happened to others Immediately after
he dapt his Hands over h s Eyes and run Home After this I took notice of several
Beggars in the City who having been imployed in that Work were either very
weak sighted or absolutely blind

He decided to study the diseases peculiar to other occupations He
went to the workshops talked to the people, studied the conditions under
^vhich they worked

The Shops or Work houses of Tradesmen are the only Schools m which we find
any satisfactory Knowledge of these Matters and out of these Places I have cn
deavoured to pick whatever might best please the Taste of the Curious and chiefly
indeed to suggest such Cautions as may serve to prevent and cure the Diseases to
which Tradesmen arc usually subject

He studied the literature on the subject and became more and more
convinced that the occupational diseases played an important part in the
life of a community

^Ve must own that some Arts iniail no small Mischiefs upon the respective Arti
sans and that the same means by which they support Life and maintain their Earn
oftentimes the Cause of grievous Distempers wh ch hurry them out of the
observed this frequently in the Course of my Practice I bent
all my Thoughts upon writing a Treatise of the Diseases of Tradesmen or Artificcn

e was aware of the fact that his subject was new and that such a first
cou not be but an imperfect performance, and yet he succeeded
t 'e ground very thoroughly describing the various trades
s indicating methods to prevent the diseases or, when
trrL< 1 therapy, of course, follows the

o t e ay He is like so many of his contemporaries in Italy an

INDUSTRIAL AND OCCUPATIONAL DISEASES 53

iatromeclianist. But the book is full of common sense and inaugurates a
new period in the history of the subject.

One other great contribution was derived from it. From then on, when
interrogatinga patient, the physician would ask what his occupation was.
Ramazzini mentions the necessity of doing tins.

tVTicn a Phj-jidan there/orc is called to visit one of the poorer and meaner sort
of People. I would advise him not to feel the Pulse as soon as he comes into a Room,
without inquiring into the Circumstances of the Patient, nor to stand, as it were, in
a transient Posture, to prcsalbe where the Ufe ot Man is concerned; but to sit
down by Ute Patient, let the Place be never so sorry, and carefully interrogate him
upon such Things, as both the Precepu of out Art, and the Offices of Humanity re-
quire us to knosv. The Divine Hippoentes Informs us, that when a Physician visits
a Patient, he ought to inquire Into many things, by putting Questions to the Patient
and Bystanders. . , . To which I would presume to add one Interrogation more;
namely, what Trade he is of. For though tfiis Question may be referred to the mor-
bific Causes, yet I reckon it very convenient, and absolutely necessary, when we have
to do with the sailgar ordinary Patients: But I find it very seldom minded in the
common Course of Practice, or if the Physician knows it without asking he takes but
little notice of it; Though at the same Time a just Regard to that, would be of great
Service in facilitating the Cure.

Morgagni in his great book De Sedibus et Counts Aforborum, published
in 17G], mentioned the former occupation of almost all of the cases he
described.

Ramazzini gave the medical world a textbook outlining a new subject.
His distinction of two great groups ot occupational diseases, one due to
the material and one due to the labor involved, was very good indeed and
tvas accepted by most physicians who in the following years %vrote on the
subject. Ramazzini’s book was a mine of information often consulted
during the eighteenth and early nineteenth centuries. As a matter of fact
the eighteenth century had very little to add to what Ramazzini had said.
Hecquet’s La Afedecine, la Chirurgie, et la Pharmacie des Pauvres, pub-
lished in 1740, contains mere abstracts from Ramazzini, and the two most
popular medical dictionaries in which occupational diseases were de-
scribed took their material from Hecquet.*® The physicians knew ho^v to
prevent many such accidents, and yet hardly anything done to protect
the workers during the eighteenth century. They had to protect them-
selves as well as they could. Ac the same time, however, the industrializa-
tion of Europe progressed faster than ever before. The steam engine in-
troduced in the textile and mining industry accelerated the development,

19 orcfionnai're dtSanti, Paris. 17«?; DieiiattMire de M^deciTte, Pans. 1772.

ON THE HISTORY OF MEDICINE

created different working conditions and, at the same time, new hazards
Mechanical forces of high potency were brought close to man, threaten
ing his life In the early nineteenth century, beginning m England, the
industrial population increased tremendously and was living and tvork
ing under appalling hygienic conditions The death rate was high and
the duration of life exceedingly short Public opinion was aroused by
the report of a committee of investigation m Manchester in 1795 The
ruling class recognized that a sick proletariat was a menace to its oivn
health Another report on The Sanitary Conditions of the Laboring Pop
ulation, published in 1838, revealed that the condition had not improved
but, on the contrary, had become even worse A very fine little book
published in 1832 by a physician m Leeds C Turner Thackrah on The
Effects of Arts, Trades, and Professions, and of Civic States and Habits of
Living, on Health and Longevity, revealed striking figures In the indus
trial city of Leeds in 1821 there was one death per 55 inhabitants, while
in a neighboring rural district there rvas one death per 74 inhabitants
At least 450 persons therefore die annually m the borough of Leeds
from the injunous effects of manufactories, the crowded state of popula
tion and the consequences of bad habits of life,” was the conclusion of
Thackrah who then proceeds,

E^e^y day we see saaiRced to the anifiaal state of society one and sometimes two
victims whom the destinies of nature would have spared The destruction of 450
persons year by year m the borough of Leeds cannot be considered by any benev
olent mind as an insignificant affair Still less can the impaired health the lingering
ailments the premature decay mental and corporeal of nine tenths of the survivors
be a subject of indillerence Nor is it in Leeds only that inquiry produces so painful
a result Leaving out of the question London and the Seaports we might prove that
Sheffield Manchester Birmingham in fact all our great manufacturing towns ex
hibit an equil or a greater excess of mortality —and an excess increasing with the
magnitude of the population If we should suppose that 50 000 persons die annually
m Great Britain from the effects of manufacturers civic states and the intemperance
connected with these states and occupations our estimate I am convinced would be
considerably below the truth Can we view with apathy such a superfluous mortality
sue a waste of human life? Assuredly an examination of our avic states and em
ployments has long been demanded alike by humanity and by science

Thackrah wTOie his courageous book to excite the public attention to
the subject ’ He was well aware that the upper class did not like to have
this subject discussed but he was com meed that conditions could be,
and must be, improsed

Most persons who reflect on the subject will be inclined to admit that our em

INDUSTRIAL AND OCCUPATIONAL DISEASES

ploymcnts are in a considerable degree injurious to health, but they believe, or pro-
fess to believe, that the evils cannot be counteracted, and urge that an investigation
of such evils can produce only pain and discontent. From a reference to fact and ob-
servation I reply, that in many of our occupations, the injurious agents might be
immediately removed or diminished. Evils are suffered to exist, even where the
means of correction are known and easily applied. Thoughtlessness or apathy is the
only obstacle to success. But even where no adequate remedy immediately presents
itself, observation and discussion will rarely fail to find one. We might even say,
that the human mind cannot he fairly and perseveringly applied to a subject of this
kind, without decided effect.

The work of the physicians was important, but it uras obvious that
conditions could only be improved by tvay of legislation. The first Fac-
tory Act, The Health and hlorals Apprentices’ Act, was passed in 1802
and tvas follo^ved in the ensuing years by other acts removing some of the
worst abuses, particularly in the exploitation of women and children. In
spite of them conditions were still bad enough.

In France it was the report of the Prefect of Police, Dubois, of 1807
that revealed the terrifying health conditions of the industrial popula-
tion. The physicians were not idle in France either. In 1822 Ph. Patissier
published a French translation of Ramazzini to which he added his own
observations. He recognized that, as a foundation for further research,
statistics should be made of the death rate in the various occupations. He
made such statistics himself for the year 1807 based on the deaths that
occurred in the Paris hospitals. The rebtionship between death rate and
wages was clearly seen by Villerm^, who, later, in 1840 published very
interesting statistics. What should be done? Patissier suggested the fol-
lowing. First, dangerous trades should be entirely forbidden or, if this
proves impossible, only criminak sentenced to death and pardoned to
bard labor should be allowed to work in such trades. Second, research
should be done so as to improve the working conditions by applying
measures of industrial hygiene. Third, the states should have public baths
easily available to the workers. Fourth, workers injured through their
labor should be compensated and should have old-age insurance. There
were 120 Socidt^s de Pr^voyance, including 40,000 workers, in France in
1822. They were mutual benefit societies organized by the Soci^t6 Philan-
thropique.

Germany tvas industrialized much later than England or France, and it
is characteristic that it was the report of a recruiting officer that drew the
attention of the public to the health conditions in the working popula-
tion. Traveling in the Rhine region, he found the health conditions such

ON THE HISTORY OF MEDICINE

that the army tvould soon be deprived of recruits. The North German
Union in 1869 in its industrial code stated that “every manufacturer must
at its own cost establish all necessary appliances for safeguarding its em-
ployees against dangers to health and life.” Social insurance was inaugu-
rated in Germany in 1883, and, as it included accidents and diseases,
provisions were made to give medical service to the working population.

In the United States the literature on oa:upational diseases began in
1837 with a dissertation. On the Influence of Trades, Professions and
Occupations, tvritten at the instigation of the New York Medical So-
ciety.*® Factory legislation followed from the middle of the century on
and developed rather slowly.

It is not until the twentieth century that there was a real improve-
ment in working conditions. The World War [I] proved to be a strong
stimulus. Workers were scarce. Their health, therefore, meant a great
deal. Research was done; chairs for industrial hygiene were established
in quite a few universities; industrial clinics were opened, the first in
1910 in New York and Milan; museums were established in various
countries showing the sources of industrial hazards and the way to pre-
vent them. The most important improvements were due to legislative
acts, their principles being the same in all countries: medical inspection
of industrial undertakings, compulsory reporting of industrial diseases
and compensation of the diseased and disabled workers. In 1906, revising
the 'Workman’s Compensation Act of 1897, England included thirty-one
industrial diseases. This act had a great influence upon the United States.

It is obvious that tlie Soviet Union would pay great attention to in-
dustrial diseases and accidents. Research institutes have been created all
over the Union, and the health of the working population is being im-
proved not only through measures of industrial hygiene but also through

c reduction of working hours, the organization of rest and recreation,
an a system of socialized medicine that makes medical care available
to all.

There can be no doubt that the working conditions have greatly im-
proved in almost all civilized countries, and yet you know as well as I that
achieved so far b just a beginning. In a highly indus-
na irc s^icty where the machine is no longer restricted to the work-
shop but has invaded the streets, the hazards will always be great. To
reduce ^cm to a minimum is only possible through the cooperative
cHoru of physician, engineer, statesman, and educator.

» Ocra/wdon and Healih. vol. II, Genoa, Inimiatioiul Labour Office, 193t. p. 381.

THE HISTORICAL DEVELOPMENT
OF THE

PATHOLOGY AND THERAPY
OF CANCER

we study the history of a disease, we can and we have to
approach the subject from entirely different angles. The first question
tve have to ans^ver will be about the occurrence of the disease. We want
to knos^^ hosv old the disease is, bow far back it can be traced in history,
when it >vas first obser\'ed. and when it was first described. At the same
time, sve U'ant to know svhere the disease occurred, tvhether it im a
widespread disease, or whether it was distributed in certain definite coun-
tries. And, finally, we want to kno^v ivhether the disease had the same
characteristics in ancient times as it has today, or whether it changed its
character, as has happened in many cases. In order to solve such a prob-
lem, sve have to investigate all the a\’ailable literature, medical or non-
medical, and, whenever possible, we will study the human remains, the
bones, and the soft tissues of Egyptian mummies.

After we have ascertained the cKXUtrenc^ of the disease, the next prob-
lem that interests us is to know how the disease svas treated by the physi-
cians in different times, what the doctor did in order to cure the disease,
and eventually to prevent it, and what results were obtained by definite
treatments. Therapy in early times was chiefly empirical. Guided by

Ddh ercd before The New York Academy of Medicine. October 20. 1932.

ON THE HISTORY OF MEDICINE

instinct, men tried out all Jdge was acquired in thts way.

in order to cute the disease. ^ ^ ^ f still use today. Therapy,

however, was not always former times we hnd a

directed by theoretical * ' .. ^na its mechanism had to

strong need for causality. The “"S j. j j foatures, were so numerous

” XhU prnt leads to a ^

ease. After we know the doctor thought of the disease

done to fight it, we wan . _ .c ,t,at oarticular disease.

-what views he had on the nature oj A" P* aiflerent groups of diseases.

The history of pathology has to instance the "sweating

There are diseases that are extinct y, . . , «iienomenon. IVe

Ickress." in such a case we study > ^.rr^ations made

have no observations of our ’ ^ow there is another

by other people and transniitted to us ‘n well known

group of diseases, the clinical features of '"‘"f ^^Yorical mecha-
fenturies ago, of which, however, the cause and he pathol g.

nism were discovered only in recent «"-Yf these our superior knowl-
tagious diseases. When we study the history “’“ii 1 literature,

edge helps us a great deal in tracing them 8 “ ^ ^^ist,

tL history of such diseases has come ^ „ me that

but we know them and we know how to fight thern. PP The

in the history of all diseases we can distinguish three d ^ P^
first might be called the erapiriral and specula i P ^ empirical
known in many of its clinical features, and i ,j,e

means with more or less success. Then comes a secon g
cause and mechanism of the disease arc discovere , disease

the third and last stage when on account of that kno 8 ,^,555^ for

can be combatted more successfully. In ‘1'='}'“°'^' ° . discoveries of
example, we have reached this last phase. Throug disease, and

Kocli and many others, we have a Uiorough knowledge o dav as it 1®
I have no doubt that we will get rid of tuberculosis some uay,
much less a medical than a social and economic problem.

Finally, we have a last group of diseases, the true nature
still unknown and for which we still have no satisfactory ™ — of

is ihc case wiih cancer. The medical historian, in tracing

PATHOLOGY AND THERAPY OF CANCER

cancer, has a very unsatisfactory task. I cannot tell you of high spots in the
history of cancer, of periods of great discoveries, of waves of enthusiasm,
as ivere observed when Koch discovered the tubercle bacillus, or Schau*
dinn the spirochete, or when Ehrlich brought out his salvarsan. The
history of cancer is a dry history of errors and of many disappointments.
The history of cancer is still in its primitive stage. The disease is still
among us. threatening human society more than ever, and the fact par-
ticularly bewildering is that we are feeing a biological problem that
doesn’t fit into our general biological conceptions. However, even in such
a case, a historical survey might prove of some interest. There might be
some enlightenment, even in the history of errors. And after all is there
not heroism in the lost battle also?

First of all, it certainly is important to ascertain that in all probabiUty
malignant tumors occurred at all times and everyivhere. Whenever we
find medical documents, the Egyptian papyri as well as the cuneiform
tablets of Babylonia or the manuscripts of old India, we find descriptions
relating to malignant tumors. And, what is more important, we have
bones of early historical man, showing evidence of such turnon.

In the medical literature of the ancient Orient, references to malignant
tumors are scarce. And yet there is one very important passage in the
Papyrus Efaers, a papyrus svritten in the fifteenth century b.c., where a
tumor is mentioned, and where it is said that such a tumor must not be
touched, meaning that in such a case treatment might prove fetal.* It is
obvious that we have no statistical data as to frequency of tumors in
antiquity. Such diseases, however, were certainly not rare— they must
have occurred rather often because in the Greek medical literature we
find a great many references to them. In the Hippocratic collection, al-
ready, we find a great many such references. Then, in the works of Galen,
in the second century a.d., there are hundreds of passages devoted to can-
cer and other tumors, and besides he wrote a special monograph on
tumors, our most important source. From the Middle Ages on, there is
not a single surgical book that has not at least one chapter on the subject.

The descriptions we find in the ancient medical literature are by no
means unequivocal. In many cases it is quite impossible to decide what
kind of tumor was meant. How can it be else? An accurate distinction of
the different kinds of tumors ivas not possible as long as there svas no
microscope. And even then the cell had to be discovered and the founda-
tions of histology laid. Our systematization of tumors presupposed the
2 Papyrus Ebers, tnssslaKd by H. Joaebim, BerJin. J890, p. J93.

ON THE HISTORY OF MEDICINE

work of Bichat, Schwann, Johannes Muller, Virchow, and others Even
today the diagnosis might be difficult in many cases, and we knoiv how
often ive are obliged to make an excision in order to make up the diag
nosis microscopically

\Ve must try to realize the situation m which the ancient physicians
were What did they see? They saw a swelling on the surface of the body
—a swelling that grew, and occasionally ulcerated They observed that
there were such swellings that had an inflammatory nature They were
red, hot, painful, and the patient was feverish They observed further
that such swellings might turn into pus But then they saw swellings with
entirely different characteristics These too grew, but they grew much
more slowly Some of them felt soft, just as does the fatty part of the body,
and proved to be harmless so far Others however, were very malignant,
and Hippocrates called these karktnos, or karkinoma, when they feh
particularly hard he called them sktrros There \vas no cure for such a
disease

As long as one did not practice dissection of cadavers the superficial
tumors only were observed And it was chiefly cancer of the breast that
attracted the physicians’ attention Its crablike appearance was responsi
ble for us name, according to Galen But by and by tumors were seen m
hidden places also, as for instance on the cervix uteri and in the anus
Sometimes tumors were felt in the abdominal cavity, and by analogy it
was assumed that these must be tumors similar to those observed on the
surface

So one result of the historical investigation is that cancer, malignant
tumors at large, represents a disease general to mankind It is not re
stricted to any country, race, or period, but is a disease of the adult in
dividual, just as are the diseases of the circulatory apparatus

To trace the history of cancer in ancient literature is very difficult,
chiefly because the nomenclature is confused The same word signifi«
different diseases in different authors We must never forget that Greek
medicine had a history of a thousand years, and tint the conceptions we
find m the Hippocratic smtings were modified to a very large extent
by the subsequent developments Another reason why the identity of a
disease described in antiquity is difficult to ascertain is that most Greek
schools had a conception of disease very different from ours They did not
consider and describe diseases as a morbid entity, but described them a*
merely symptoms or groups of symptoms It will be the task of investiga
tors to examine the whole Greek literature very carefully m order to find

PATHOLOGY AND THERAPY OF CANCER 61

out what the actual knowledge of the Greek physicians tvas in the case of
cancer.^

What was the ancient therapy o£ such disease? In many cases the most
salient feature was the ulcer, and the same treatment was applied as was
used for other ulcers. Drugs, and chiefly metallic salts-salts of copper,
and lead, then sulfur and arsenic— were applied, preparations that proved
efficient in other cases and helped in the formation of granulations. Such
treatments were recommended from Hippocrates on, even to our days.
Sometimes the author reported that he had good results, and that the
tumor was cured. But now, of course, we know that such a tumor in all
probability was not cancer. Most of the ancient authors, however, did not
expect much of such remedies and tried other cures. They tried to destroy
the growth either by cauterization, or then they cut it out srith the knife.
But these operstive treatments gave bad results, too. They did so because
the surgeons had not the pathological-anatomical knowledge nor the oper-
ative technique necessary for such radical operations. They resigned, and
the resignation of the most outstanding physicians in antiquity is perhaps
best expressed by Celsus in his famous Encyclopaedia. He says;

Some physi'uans used caustic remedies. Some cauterized, and others operated
with the knife. The remedies, however, newr did any good to anybody. On the
contrary, by cauterization the tumors were activated, and grew the taster, until the
patient died. When they were cut out they came back after the scar had been formed,
and brought death also. To distinguish a benignant tumor that can be cured from a
cancer that cannot is hardly possible. All we can do is to watch and see what will
happen.

In spite of the resignation there were always surgeons tvho tried to
help the patient by operating on him. Celsus himself recommends the
operation, in some cases, for instance, for tumors of the lips, and an Alex-
andrian surgeon of the second century a.d., Leonides, seems to have had
a method of operating on cancer of the breast. He operated only when
the tumor was not too for advanced. He amputated “a sanis partibus”
and cauterized the whole wound.

The pessimism, hosvever, prevailed for many centuries. A Salernitan
surgeon, Roger, tells us that he sometimes saw cancer of the uterus oper-
ated, but without any result; on the contrary, die patients died much
sooner than they would have done without any treatment. And a century

* The book of Jacob Die Lehre t’on der Krehjkrankheit, >ols. 1, 11. and III, Jena,

1907-1913. is lery valuable for the more recent period. In ihe chapter dealing vriih antiquity,
the author generally mes secondary sources and is far from being satisfactory. I hope to
publish a paper on this subject in the not loo far disunt future.

ON THE HISTORY OF MEDICINE

later another great surgeon, Lanfranchi, makes the very reasonable state
ment that cancer must not be touched i£ it grows in parts o£ the body tha

are nervis vems, et arteriis mtricatis They all agreed that only radical

operations on an early growth would have any success, but radical opera
tions at that time without satisfactory anesthesia, and without the means
of preventing infection were hardly possible Whether a cancer wm
operated or not depended chiefly on the temperament of the surgeon the
results in both cases being nearly the same, with very fesv exceptions
The history of the therapy of cancer is very dull The principles we
are following today, namely, the elimination of the tumor as radically as
possible, were discovered in far remote antiquity Our operative methods
are much more efficient than theirs were, and besides the knife we have
X rays and radium to destroy the tumor cells, but we have not found any
new principle yet ^ tj

And now to the problem, what did the physicians think of cancer? Ho
did they explain the phenomenon of swelling? It is obvious that t e
theories of cancer were in accordance with the general pathological con
ceptions of the different periods If I were to trace the history of the cancer
theories m detail, I would have to trace the whole history of pathology
So all I can do is to point out some of the most important theories Greek
medicine distinguished three different kinds of growths One, secundum
naturam, was the physiological growth, the growth of the developing
organism the growth observed in the pregnant uterus, or m the physio
logical swelling of the breasts Another was the growth supra naturam, a
growth pathological only in its quantity, as happens for instance when
a callus IS formed after a fracture And finally there is a growth praeter

naturam an abnormal pathological growth— the growth of the tumor
According to the physiological theories of Galen, who developed an
systematized the Hippocratic views there were four ' humors m the
human body blood phlegm, black and yellow bile If they were we
balanced man was healthy A disturbance of this balance meant disease
The theory of the four humors was not bad at all It explained a
many facts and as a working hypothesis gave quite good results ^ ^
case of tumors obviously there, too, the balance had been upset Whic
humor was responsible for it? Galen thought that it was the black bi e
■\Vhy? It seemed to him that people in whom the black bile dominate
physiologically were disposed to tumors It was believed that the blac
bile became thickened and that m this svay the tumor originated

The Greek pathologists knew that m the human body there is a natura

PATHOLOGY AND THERAPY OF CANCER

healing power that endeavors to restore the lost balance of health. In all
inflammatory processes, the rvay this healing power works seemed per-
fectly clear. The inflammatory swelling turned into pus, and the pus
tras drained out. In this way the materia peccans left the body and the
balance was restored. In the case of cancer, however, it seemed that the
healing power of the organism did not work. There was no natural heal-
ing of tumors. The doctors’ rules usually followed to help the organism
in its healing tendencies could not be followed in this case. So in an-
tiquity as well as today cancer did not fit into the general pathological
conception. It tvas a puzzling problem for which satisfactory explanations
could not be found, although Galen and many others did not admit it.

This theory of Galen’s had consequences for the treatment also. Can-
cer, being the result of a disturbed mechanism of the humors, having
therefore an internal constitutional origin, had to be treated internally
too, and indeed Galen describes a certain diet to be followed by the
patient suffering from cancer, ^fo^eover, by applying purgative remedies
and bleeding the patient, he endeavored to influence the humors. Galen’s
theories survived as long as the theory of the four humors did— that is,
throughout the Middle Ages, the Renaissance, and far into the eight-
eenth century.

In the seventeenth century, however, a new explanation tvas sought
for, according to the new pathological conceptions of the time. The dis-
covery of the lymphatic vessels played a very important part. One thought
that it was the lymph that carried the cancer material and, more than
that, that the lymph was responsible for the gathering of tumors. The
vague hypothetic humors of Greek medicine did not satisfy the physician
any longer. These had achieved much in the realm of science. The car-
riers of the balance of health were no longer thought to be the humors
but rather the physical forces and chemical substances. And such a sub-
stance was that lymph. Alterations of the iymph-its thickening or coagu-
lation-might be responsible for the origin of cancer. The French school
advanced this theory, as did John Hunter, and this theory brought further
new improvements in the treatment that resulted in operating on or
removing the lymphatic glands and destroying the lymph vessels in the
area surounding the tumor. The operation became more and more radi-
cal, as for instance in the case of the cancer of the breast, where the pec-
toralis major was removed, as it was feared that it might be affected by
the lymph.

Particularly interesting are the views of John Hunter, a man we appre-

ON THE HISTORY OF MEDICINE

ciate the more we study his works He, tob, believed in the theory of the
coagulated lymph But his conceptions are not the naive mechanical ones
o£ the past century They are entirely biological Cancer to him is a part
of the body comparable to an organ It is nourished by the vessels of the
organism And therefore he tried to isolate the tumor by compressing
the blood vessels leading to it, or by making ligatures
The lymph theory, however, was not satisfactory either Doubts were
expressed, chiefly by Morgagni In his dissections he found a great many
tumors, and was convinced that they were more than the result of the
coagulation of the lymph And yet he could not find any better explana
tion In 1773 the Academy of Lyons offered a prize for the best ansv^^er
to the question ‘ What is cancer? ’ A young man by the name of Bernard
Peyrihle got the prize for a thesis that gives a very good summary of the
^ nowledge of the time There must be special cancer virus," he said,
that IS responsible for the alteration of the lymph " He tried to make
experiments He injected cancer material, taken from a cancer of the
breast, into a dog Unfortunately, the experiment did not come to an
end The dog barked so terribly that it was killed by the doctor's

lanrilaHv '

In 1802 a society for investigating the nature and cute of cancer was
founded in England It issued a questionnaire that was sent to all promt
questions of which could not be more sensible
What are the diagnostic symptoms of cancer? ' • What is the nature of
rancer, principally its pathological anatomy?" "Is cancer a primary
disease or can cancer develop out of other diseases?" Is cancer heredi
Unfortunately the society was disbanded four years
later without obtaining any significant results

It was too advanced for the t.mes In 1802. the year that this committee
was appointed a man died in Pans who opened new horizons for patho
ogical research, Xavtet Bicha, His ways had to be followed in studying

ne? m r/ ■■"'“'■gallon of the tumors by the

anatomy The French school followed
thffiro To iT 'T" '"■* nn the subject Lacnnec was

While « erentiate etween homeoplastic and heteroplastic tumors
r “ - P'-oncerous condition, he do

Then th ^^if ° ® growth of the connective tissues *

Then the cell theory was established, and Johannes Mullet applied it to

» - -lima

PATHOLOGY AND THERAPY OF CANCER

the tumors. Cancer was described by him as the result of specified cell
formations svithin the connective tissues of an organ. Virchow's work
followed in the middle of the century. He described the heteroplastic
tumors as proliferations of the connective tissue cells as a reaction against
some kind of irritation. Thiersch and Waldeyer brought important
modifications to Virchow’s theory, and then Cohnheim established the
theory of the congenital foundation for cancer. The twentieth century
finally was devoted chiefly to experimental research that was made possi-
ble by great advancement in physiological chemistry.^ Today we know
infinitely more of the biology of cancer than ever before. And yet the
problem is still unsolved. In the last fifty years a great many theories
were brought forth, but they all proved to be tvrong. Our therapy is much
more efficient today than it was before this time, and yet we have not
found anything neiv. We have foUowed the principles and improved on
the methods that the Greeks already had, and our results are far from
being satisfactory. I remember the great Berlin surgeon August Bier said
to me one day, “If a great scientist at the end of a brilliant career wants
to make a fool of himself, he takes up the problem of cancer." This, un-
fortunately, happened in many cases. And yet the stronger the enemy,
the more energy and the more intelligence we will have to develop in
order to uncover his face and to fight him.

I personally have the feeling that the problem of cancer is not merely
a biological and laboratory problem. But it belongs to a certain extent
to the realm of philosophy. This, an X in the pathology of cancer, is a
principle we do not understand yet. While we can understand most
pathological processes as defense reactions or as healing processes, here
we- are facing a fact that does not fit at all into our general biological
conceptions. Fortunately, we have overcome the speculative era in medi-
cine. We know that a theory is not true by the mere fact that -we think it
to be so, but it has to be demonstrated and proved experimentally. And
yet all experiments require certain philosophical preparation. And I
have the feeling that in the case of cancer many experiments were under-
taken ttfithout the necessary philosophical background, and therefore
proved to be useless.

* “Experimental Cancer, an
delphla General Hospital, by '
tory, 7 , 1925.

Historical RetnMpect.“ from the laboratories of the Phlla-
E. B. Krumbbaar, PWIadelphia, Pa., AnrtaU of Medical Hit'

AMERICAN SPAS
IN HISTORICAL PERSPECTIVE

rn Europcin pli>sician who comes to Amcnca it is tcrystrAing

suuahon w T

u calls for a^anaTysf,

Mineral springs attracted the attention of people tcry early on account

neon <>' Xter Instinctitel).

fhem '"i"® ^"^7 uilmenls made use of tliem by bathing m

tioXr "'“"S >'■=■■■ sufferings, a tradi

xtensiveZ" T7 "a

have been a SP""!? they found, and Roman objects

oZe earl MilT a'" Z'' 'P“ ' >" »■=

thevuer 1 ^ of niany springs wis for^jottcn but

they nere rediscovered in the later Middle Ages and in the Renaissance '

Read below .he John, „opV,„. Med.ral civb ob N„,e„ber 3 1911

«e Al(,ed"Mo't." SX'oodL'e™'! u vew nth For general mrv^

Ge,ch,ch.e der Balneoloew „r,d “rgengenen Tagen Jena IMC ron OeWe

Ceschtchu der “ t Grcnzgebicte in der Neiireit in Itandbueh der

vol 2 PP 589 603 Bernh ts“t^SeUen von Max Neuburger und Jubu* Fagel Jena 1903
nndPegoVeie Wd„bn"g ^ Cereb.ebie der Balne.log.e ;/,drof...e

AMERICAN SPAS

This revival was not only due to the desire of making natural curative
forces available and to an improved road system that made traveling eas-
ier, it was also a result of the development of the city. As long as people
lived under rural conditions, they did not feel the need for a vacation
spent in a different environment. The city dwellers, however, who lived
the whole year round confined within the city walls, developed a desire
to leave the town for a few weeks every year and to spend the time in
totally different surroundings. Many mineral springs are located in pleas-
ant landscapes, often in mountainous regions svhere the climate is invig-
orating. ^Vhat rvas more logical for a family svho could afford it than to
spend a feu’ weeks at a spa? There the members svho were not sick found
good company, recreation, and amusement, and those who svere suffer-
ing from some chronic ailment could obtain a treatment which greatly
alleviated their condition. Thus many European spas became general
health resorts and fashionable meeting grounds for vacationists, sought
by sick and healthy alike. Others that were difficult of access, such as
Pfeffers in Switzerland where the spring is at the bottom of a steep gorge,
had no amusements to offer, but their waters were famous and were used
by an endless number of patients who could not be deterred by the hard-
ships of the journey.

Afedicinal springs and their curative powers are mentioned by ancient
and medieval medical witers. The virtues of the waters of Pozzuoli and
other spas were described in the Middle Ages in special monographs or
pamphlets. The revival of scientific interest during the Renaissance drew
the attention of physicians to the springs more than ever before.* Para-
celsus did pioneering work in this field also. Equally experienced in med-
icine and chemistry, he visited many European spas and analyzed their
waters. He frequently mentions medicinal springs and their use in his
tvritings, and he wrote a little monograph on Pfeffers,* a place which was
sought in those days by many famous syphilitic patients. From the Ren-
aissance on, the literature on balneology increased considerably.

The European spas have been used for over 2000 years. Medical theo-
ries changed. Galenic doctrines dominated medicine for almost fifteen
centuries. Paracelsus attacked them and developed a new theory of medi-
cine based on chemical concepts, latrochemists and iatrophysicists, mech-
anists and spiritualists, had their periods of vogue until a medical science

3 S« the collection De Bflfnew, Venice, 1555. which contains the most important mdent
and medieval texts on the subject.

* Von dem Bad PJfffen in Oberuhwylz gelegen, 1535 .

ON THE HISTORY OF MEDICINE

based on anatomy and the other natural sciences developed But what
ever the theories were, patients for over 2000 years went to tlie spas
bathed in their waters drank them, and found relief Every medical the-
ory ivas used to explain the effect of medicinal ^vaters The explanations
changed, but there were ahvays results In every century patients were
benefited by their cures

Today research institutes have been established in various European
spas and the effect of the waters is studied in clinics and laboratones
Medical students are instructed in the use of the ivaters When I a
student at the University of Zurich we were given theoretical instruction
in the course on experimental pharmacology The indications for treat
ment in watenng places were discussed in all clinics, and once every year
all clinical students went for a visit to one of the famous spas of the coun
try There we were given lectures and clinical demonstrations by the
local health authorities and physicians and we had an opportunity to
study the facilities of the place Thus in the course of six years we came
to see the various types of spas and learned what they could achieve

Many European spas are owned and administered by the communities
or by the state but even in such a case they are usually operated on a
commercial basis They are eager to attract visitors and their advertising
IS not always strictly scientific Commercial and medical interests fre
quently clash A new development took place in the Soviet Union where
all health resorts with all their facilities are owned by public institutions
and operated as a public service* Tliey are administered by the health
authorities so that there cannot be any commercial interference of any
kind Russia has developed the science of health resorts more than any
other country A central research institute in Moscow with laboratories
and a clinical division directs activities and serves as a clearinghouse
Local research institutes have been established in a number of cities and
in all the important health resorts Today already more than a milho^i
patients are treated every year m spas usually at the expense of the social
insurance funds or the trade unions The development of health resorts
has been one of the most brilliant achievements of Soviet medicine and
there is no doubt that the program will be continued m increased meas
ure after the war

When we turn to the United Stales the picture is very different The
country is very rich in medicinal springs particularly in the region of

189*” ” So«a/iz«<i Med$ctne m the Soviet Unton New York 1937 pp

AMERICAN SPAS

the Rocky Afountains and the Appalachians. I do not think there is one
mineral rvater in Europe that could not be matched in America. The
countr)' has 2717 areas in which medicinal springs are found, with 8826
springs.® Wyoming is leading with 2244 springs; next follotrs Texas, then
Afissouri, California, Colorado, New York; North Dakota is at the bot-
tom of the list with no known mineral springs at all. Of all areas explored
in the country, 424 are used commercially and 321 have been developed
at some time or other as health resorts. This seems an impressive figure.
Yet when sve examine it more closely we soon find that many resorts have
been discontinued, that many are undeveloped, with poor accommoda-
tions, poor medical facilities, and no facilities for research at all. The
number of spas that can compare today with the best European ones
hardly exceeds a dozen.

According to tradition the Indians were the first to use the mineral
springs of the country for medical purposes, and they are said to have
drawn the attention of the white man to the waters and their curative
powers. Several of the Virginia springs were already used in colonial
days.’’ Virginia Hot Springs in the Alleghenies was visited by white men
as early as 1720, and the first tavern svas built there in 1766. The highly
radioactive water, which has a temperature of 110 degrees, became very
popular and has remained so to our day. The spring, which today is in
Berkeley Springs, W. Va., was the property of Lord Fairfax, who gave it
to the colony of Virginia before the Revolution. In 1775 the assembly
of Virginia decided to build a toivn around the spring and began selling
lots. The place was called Bath, and it was to become an American Bath
comparable to England’s most famous svatering place. George Washing-
ton used the svaters. The spring has remained state property. White Sul-
phur Springs, W. Va., was used from 1778 on, and the first cottages ivere
built in 1804. Sweet Springs, W. Va., ^vas discovered in 1764. Beginnings
were primitive there as in other places. Log cabins were erected around
the spring in 1773, but there was no bathhouse and people bathed in an
open pool. A two story hotel was built in 1792, and the place soon be-
came a health and pleasure resort.

Many other medicinal springs were found in the mountains of Vir-
ginia. and in the )830's it became the custom to take the springs tour

«W. P, Beazeli Th^ S<Ms <,/ thr Viiud SMn. Report of lie Saratoga Spring.

Commiaion to thi Legiilatnte. Legi.lalite Docomert PSOO) No. Jo, altan,, J9!0.

t Perteval Rmieis, Th, spring, o/ ritgiri,. L-lr, tow. anri C™'* “ "Jt-

xm. Chapel Kill. N.C., Z91I-

ON THE HISTORY OF MEDICINE

using the waters m succession Such a tour was a social affair since every
spa provided a variety of entertainment The Philadelphia physician
John Bell, one of the pioneers of American balneology, in his book On
Baths and Mineral Waters, published in Philadelphia in 1831, is full of
praise for the Virginia springs and says

All that has been performed by the Bristol Buxton and Bath waten of England
may be safely claimed as of easy fulfilment by the use of the Virginia s^alers }ust
enumerated If to these springs— the Sweet, the Warm and the Hot, be added the
White Sulphur, the Salt Sulphur and the Red Sulphur, we can safely challenge any
district of country of the same extent in the world as that in which these springs
are situated to produce the same number and variety, whether we have regard to
mineral impregnation or temperature or the use of which shall be attended with
more speedy entire, and pcrraanem relief from a host of the most distressing
maladies

John Bell however, is well aware not only of the curative forces of
the Virginia springs but also of the beauty of the landscape

In addition to the inducements presented to invalids and the inhabitants of our
northern and eastern cities by the springs themselves there are all the pleasures to
be derived from scenery of the most varied and picturesque character— natural eb
jects without number calculated some to inspire with sentiments of the sublime
at their sue grandeur and wild appearance others to fill the breast witli tranquil
emotions at the sight of the softened beauties of the landscape spread out before
them

Other famous spas were developed m the early nineteenth century,
first of all Saratoga in the state of New York The -water of Saratoga had
long been known to the Mohawk Indians who used it in the treatment
of various diseases They brought white people to the spring George
Washington came in 1783, was interested, and even thought of purchas
mg the High Rock Spring ® The history of Saratoga as a health resort
began when Gideon Putnam built the first tavern in 1803 and laid out
the village two years later From 1806 on, the sulfur waters of Clifton
Springs, N Y , were used, and Dr Henry Foster built a sanatorium there
m 1850 In Pennsylvania the Bedford Springs were discovered m 1804,
and the place became a very fashionable resort The Arkansas Hot
Springs were made a national reservation in 1832 and thus remained the
property of the federal government, which established a number of bath
houses from 1878 on In the Middle West, French Lick, Ind , was devel
oped as a spa from 1840

8 Hugh Bradley Such ifai Saratoga, New Yml:, 1940

AMERICAN SPAS

In the middle of the nineteenth century the American spas had a pe-
riod of great vogue. They Avere famous not so much for their tvaters as
for their horse races, gambling places, theaters, and other entertainments.
They were resorts for the idle and rich, with luxurious hotels, parks, and
casinos. The tv'aiers were used, to be sure, because it ti^as fashionable to
use them, but in most cases they were a mere accessory and a pretext for
social life.

The decline came toward the end of the century. Many spas were dis-
continued; others still shotv the remains of former splendor, gigantic
hotels that are closed most of the time, casinos that have been turned into
dusty museums. The glories of the old days ti'hen southern landlords,
New York millionaires, adventurers, and expensive prostitutes mixed in
glamorous intercourse are revived from time to time in novels such as
Edna Ferber's Saratoga Trunft.

There are various reasons for the decline of the American spas. At the
turn of the century they had to compete with other resorts, particularly
those at the seashore such as Newport and Atlantic City. The spas had
an asset which other places had not, namely their medicinal springs. But
the fame and popularity of the spas in America, unlike Europe, tvas not
based on the curative powers of the waters but on the accessories, the
entertainments and amusements that other resorts could supply just as
well.

At the same time in the 1890's, American medicine ^vas becoming sci-
entiHc. The Johns Hopkins Hospiul and School of ^redic^ne had been
opened, and physicians were trained in laboratories and in hospital
wards. Most of the spas were privately owned and operated for profit.
The waters were frequently advertised as cure-alls in a manner that did
not inspire confidence among scientifically trained physicians. The logi-
cal step tvould have been to establish research institutes in order to ascer-
tain scientifically what balneological treatment could effect. The coun-
try, horvever, was busy svith the reorganization of its medical schools and
hospitals. Other scientific problems seemed much more urgent, and the
physicians with few exceptions simply discarded the spas.

If you ask an average American doctor rvhat be tliinks of treatment in
a health resort, he will smile ironically and will tell you that such a treat-
ment can do no harm but is hardly more than some kind of psycho-
therapy. While balneology is paid increasing attention m Euro^an med-
icine, American medicine as a whole persists in neglecting it. There are
various reasons for this peculiar American attitude.

ON THE HISTORY OF MEDICINE

One, I believe, is that American patients as a rule are anything but
patient. They want to be “fixed up” quickly. They want an operation
if possible or, if this cannot be done, they %vant at least injections. Treat-
ment in a health resort is an affair of several weeks, and such a lengthy
treatment does not appeal to the average American patient quite apart
from the costs involved. The trouble is that chronic diseases cannot be
cured quickly.

But then there is another more complicated, a social and economic,
reason. In Europe from the Middle Ages on, every spa had its “free bath,”
a section where indigent patients were treated free of charge. Consider-
able donations were often made to increase facilities for the poor. And
when in the nineteenth and twentieth centuries health insurance was
introduced in one country after another, treatment in health resorts be-
came available to large groups of wage earners. The sickness insurance
funds sent many patients to spas where they were treated at the expense
of the funds. In Europe, therefore, such treatments were not a privilege
of the rich.

The situation is totally different in America. We have no health insur-
ance. We have no organitation that would enable us to send large num-
bers of people of low income to health resorts. I know that some spas
have plans for patients of moderate means and that they give charity
treatments. “The U. S. Public Health Service maintains a Medical Cen-
ter in Hot Springs National Park, Arkansas, for the treatment of medi-
cally indigent patients who are infected with venereal diseases. Patients
are admitted only through the National Park Service Free Bath House
where personal evaluation is made of each individual's financial status,
and an oath of medical indigency is administered."* In the fiscal year
1940, 4662 persons applied for treatment and 2280 were admitted for the
treatment of venereal diseases.^* Saratoga Springs gave 23,245 charity
treatments in 1939 to 1940. Since a "cure” requires about 18 treatments,
the number of people reached was not very large. Some other spas may
have similar provisions, but in a population of 130 millions this is not
more than a drop in the bucket. Besides, it is not only a question of free
treatments. Patients must travel to the spas, must lodge themselves, and
first of all must be able to afford the loss of several weeks’ wages.

As conditions are in America, treatment in a spa is primarily for people

e From a circular of the United States Public Health Service.

lOAnnual Report of the Surgeon General of the Public Health Service of the United
Slates for the fiscal year 1940, p. 144,

AMERICAN SPAS

of some means. Rich people, however, preferred to seek the highly devel-
oped European resorts where an ocean separated them from their office,
where they were sure to find the best possible medical facilities, highly
competent physicians, and the many amenities that such places usually
offer. It has been estimated that in 1930 100,000 Americans took treat-
ments in European spas, spending 100 million dollars there.^*

As a result of these conditions most American spas remained undevel-
oped or became social resorts, more fomous for their golf courses than for
their waters, and the consequence ^vas that our medical students were not
instructed in the matter and that the majority of our physicians therefore
believe that treatment in health resorts is a swindle or at best a dignified
medical superstition, if not a European racket.

It is very unscientific to deny the experience of 2000 years merely be-
cause we have no ready-made theory that explains all phenomena in
every detail. It would have been foolish to deny the existence of light-
ning because electricity tvas not yet known. Experience has preceded sci-
ence in medicine more than once. Our most valuable drugs, quinine,
digitalis, opium, mercury, and many others, were given for centuries,
long before pharmacology was able to explain their action. Oskar Bau-
disch has very pertinently shotvn how similar the situation was with re-
gard to heliotherapy.^* Sunlight tvas used as a healing agent for centuries.
Rickets were treated with ultraviolet rays. To “scientific physicians” this
was a mere superstition— until the vitamins svere discovered and it was
found that sunlight changes the crgosterol of the skin into vitamin D.
Chemistry until recently was gross chemistry; microchemistry is in its
infancy still, and we are beginning to realize that a few molecules of a
chemical compound can cause definite biological reactions. The theory
of dissociation and the discovery of radioactivity greatly stimulated the
study of medicinal springs, and Baudisch has pointed out how important
and illuminating Alfred Werner*s concept of coordination valency (co-
valency) is in this particular field.*’

The scientific attitude toward spa treatment, in my opinion, is to use
natural curative forces on the basis of the rich clinical experience al-
ready available today, and at the same time to promote laboratory and
clinical research most energetically.

U W. P. BeazcH. op. cit.

IS Osfcar Baudisch. "Magic and Science of
£duca(ion 1^:442, 1959.

13 Baudisch, ibid., pp. 443-446.

Natural Healing Waten," Journal of Chemical

ON THE HISTORY OF MEDICINE

There are encouraging symptoms that show that American medicine
IS beginning to overcome its destructive skepticism and is developing a
scientific attitude in this field also The turning point came when the
state of New York established a research institute at Saratoga springs the
first research institute of its kind on the American continent The history
IS interesting At the turn of the century the decline of Saratoga as a
health resort was so great that a commercial company was exploiting the
waters pumping out 150 million gallons a yearl The natural carbonic
acid gas was extracted and used for the charging of various manufactured
beverages The springs ceased to flow and the country was threatened
with being deprived of some of its most valuable medicinal waters
At this critical moment the stale of New York stepped in In 1909 the
legislature passed a bill enabling the state to take control of the springs
The area with us 163 springs became a state reservation It took seven
years for the springs to return to their old level The state then decided
to develop the spa In 1929 it appointed a commission with Bernard M
Baruch as chairman to make a comprehensive study and survey of the
mineral springs at Saratoga The commission consulted with geolo-
gists and foreign balneologists in cooperation with the New York Acad
emy of Medicine it appointed a committee of physicians who made m
tensive investigations both at Saratoga and at the chief resorts of Europe
The following year the commission already was able to present definite
recommendations to the legislature The state of New York spent 8 5
million dollars and iti 1935 the new Saratoga spa was opened When it
was completed the next year it included a group of beautiful buildings
a hall of springs two new bathhouses a recreation unit a hotel and a
bottling plant

This was splendid in that it gave the country a unique health resort
with facilities that compare very favorably with those of the best Euro-
pean s^as Still mQre.Mgiifir;u[j/. bnwevex devel

opment included a research institute It was named after Dr Simon
Baruch Bernard M Baruch s father a physician of vision who long be
fore had had such a development m mmd Research is the spring that
feeds all medical activities When practice is dissociated from research
It soon degenerates into mere routine Intensive research is particularly
needed in such a field as balneology that has a long empirical but a very
short scientific history

1* Report of the Saratoga Springs Cominin on to the Legislature Legulauve Document
(1930) No 70 Albany 1930

AMERICAN SPAS

This was clearly realired by the committee of physicians chat
report to the legislature of 1930 recommended:

in its

(c) That steps be Ukcn toward the establishment of a scientific institute at
Saratoga ■whose functions should he threefold.

The first function would be to provide modem laboratory facilities for diagnostic
work, this to include facilities for radiology, cardiology, basal metabolism, serology,
bacteriology, and other diagnostic aids.

The second department, closely linked to the laboratory, would be devoted ex-
clusively to research work in balneotherapy, and other methods of treatment of
chronic disease. This department would offer the physicians of the state educational
opportunities for the study of the nature and treatment of chronic diseases.

The third department rvould be giten over to the study of the geology of the
district and the physical and chemical properties of the waters; this department
to be under the direction of a competent modem chemist, while the laboratory
and research divisions to be under the direction of a skilled medical director with

a good clinical background, and of a research type of mind. The research and
experimental work, as well as the educational facilities, might be associated with
one or more medical schools of the State. A direct a/Tdiation ■with the Albany
Medical School readily suggests itself because of its proximity to Saratoga Spring.

The relationship of the institute to (he medical practitioners should be worked
out in conference with representatives of the State Medical Society and of the
local physicians.

(d) In connection with this institute a fully equipped depanment of physiotherapy

should be developed- It should comprise facilities for the various kinds of physio-,
thermo-, hydro- and electrotherapy, as well as inhalatoria, gas baths, sun baths, open
air as well as enclosed gymnasia, and other features of special therapy.

(e) The institute should be built on State property in dose proximity to the
bathing establishments. In its directly utilitarian aspects, i.e., in its laboratory work
and its physio-therapeutic equipment, it should be built and maintained by the
State, although in all probability the diatges made for service rendered will cover
the cost of its maintenance. For the research works, which would be one of its
outstanding features, continuous maintenance should be assured. This institute
should be matiaged by a board of trustees, or a board of sdenUfic control, appointed
in a manner which will properly safeguard its purpose.

(0 The selection of the hfedical Director and his staff should be the responsi-
bility of the board of trustees or the board of scientific control.

(g) It would, perhaps, be desirable to consider a plan whereby feUowships would
be granted to young physidans for travel and study abroad, and to organize, at
Saratoga or elsewhere, courses in balneotherapy when the opportune time comes.

(h) The clinical material for research purposes could come from both the ordina^
patients and the patients who would be accommodated free of charge, or at greatly
reduced cost. A rule should be adopted that no one could pursue a cou«e of
treatment at Saratoga without medical direction by physiaam recognued by the

management of the spa.

ON THE HISTORY OF MEDICINE

The foundation of the Simon Baruch Research Institute marked a
date in the history of American medicine It signified that America ivas
catching up with European medicine m this field also, that balneology
was becoming— very belatedly— a saentific discipline in this country as it
already was in Europe The institute was well conceived and ivell
planned The founders were aware that this was a new departure in
American medicine and that the institute would have far more than lo
cal, that It would have national, significance If anything, the research
work of such an institute would be able to overcome the ignorance of
the average physician about balneotherapy that was depriving thousands
of chronic patients of the benefits of such treatments Unfortunately the
funds anticipated for the maintenance of the institute were not forthcom
ing It IS operating today, but on a very limited budget Only part of the
building serves its original purpose, and it is sad to find a dancing acad
emy and a theater in rooms that were to be those of a temple of science
A beginning is made nevertheless and with Dr Walter S McClellan as
Medical Director and Dr Oskar Baudisch as Research Director, the
Saratoga Springs Authority has embarked on its research program Since
private funds seem unobtainable, it is to be hoped that the State of New
York which has shoivn so much foresight and wisdom m developing the
spa Will be aware of the historical significance of its research institute
and will support it adequately for the benefit of the entire nation

I would like to mike a strong plea for the development of our Amen
can health resorts We need them, not because European resorts are un
available at the moment There is no reason why our patients should
have to go to Europe for such treatments We need them because the
chronic diseases, the diseases of mature and old age, are in the fore
ground, our major health problems today We shall need them badly
after the war not only for the veterans of the armed forces but also for
the veterans of labor

We need our resorts not only for the treatment but also for the pre
vention of serious diseases We could use them as centers of rest and
recreation under medical supervision After a year of hard work in facto-
ries and in the fields, hundreds of thousands of men and women need
more than a vacation They need some repair The fruit picker after a
season of backbreaking v\ork, the miner who for months inhales dust,
the steel vsorker handling the white hot metal, the textile worker spend
ing the whole year standing at the loom, the elevator boy who lives in a
cave, the shop girls and waitresses who try so very hard to conceal their

AMERICAN SPAS

weariness and anemia witli rouge and paint-how would it be if they
eould spend a few weeks in a health resort, have a phys.ml check-up. com-
bine vacation with treatment, and have their minor '

of hard work, treated before they develop into serious diseases-their
beginning rheumatisms, arthritis, bronchitis, digestive troubles, vancose
veins, gynecological ailments? Would this not be sound preventive medi-

rtnp and sound economics as well? ... • j

TiTs is not Utopian. There are countries where this is pmcticed on a
h-i^e scale. We can do it also. All that we need is organization and intell -

pointment of a -j-nistees and consists of highly com-

ims duly appointed by the Bo

petent men with great c-xperten resorts.” It has estab-

Lmittee is preparing a ^

lished minimum reqitiremenu that a hea separate the

can be included in the list. This is , standards,

tares from the wheat. It will protect the of scientific

As a second move the committee i P P published

papers on various phases of ‘ . j^^^ciation and. as I hear, may

in the /ottmal o/ the American Med, cal Assoc, at.on

later be issued as a volume. beeinniuE. The committee with-

All this is a sound but a very "> among which will be

out any doubt will soon have to lace other tasks

the following: or^trarch One institute obviously

I. Insistence upon the b a variety of natural curative

is not enough in so large a country i founded in strategic points

forces. Additional research f^om those of Saratoga Springs,

where the curative factors are diHere ore

Institutes must have laboratory —edical supervision, it is difficult

hospitalized and thus Health authorities, state and federa .

to obtain accurate clinical <>“• • jj should be demonstrated to

must be interested in such P™J“ • ^re self-liquidating and will

politicians that investments m hralt occur, since

ultimately represent a cons'de«We ra« development of serious dis-
treatment in health resorts can prev« diseases.

■. abliug illnesses and reduce the disabili y
IS,.™., o,.!,.

ON THE HISTORY OF MEDICINE

2 Provision of teaching facilities Since ignorance of the average
physician is the chief barrier, instruction must be provided and must
begin ivith the medical students No medical school has a chair for bal
neotherapy yet, and most clinical teachers have little experience in spa
treatments A first step toward solving the problem would be the estab
lishment of research fellowships in the major spas of the country as the
committee of physicians of Saratoga springs already recommended in
1930 Young clinicians would thus have an opportunity to become ac
quainted with the various health resorts and their therapeutic possibili
ties After having returned to their schools they could instruct students
Physicians could be instructed in postgraduate courses of several weeks
duration

3 Creation of a literature Our literature on the science of health re
sorts is very poor compared with that of European countries The Sara
toga Springs Authority has taken the right step in publishing a senes of
very good pamphlets The scientific papers prepared by the Committee
on American Health Resorts will be a most welcome contribution We
have William Edward Fitch s book Mineral Waters of the United Stales
and American Spas, published in 1927, which is the worthy successor to
the works of John Bell (1831 and 1855) « John J Moorman (1867)*^
George E Walton (1873) « A N Bell (1885) » and James K Crook
(1899) We have no book however, that could m any way compare with
the Handbuch der Balneologte, mednintschen Klimatologie und Bal
neagraphie,^^ which has not been translated into English A journal will
have to be founded sooner or later It will create a link between the
various resorts and serve as a clearinghouse for scientific information
Its financing should not be difficult The health resorts admitted to the
approved list could be called upon to make initial contributions until
the journal is firmly established

4 Organization of an American society for the science of health re
sorts, or whateser it may be called There is an American Clinical and
Climatological Association that has a very distinguished record Its chief

I80n liaths end Mintfel naUn etc Philadelphia 1831 The Mineral and Thermal
Spnnui of the United Stales end Canada Philadelphia 1855

The Mineral nater of the United States and Canada IJaUlmore 1867

18T/ir ^Uneral SffTings of the Uniied Slates and Canada New York 1875

l^Chmatolosy and MineralMalers of the United Slates NewYork 1885

20 The Mineral It alers of the United States and Their Therapeutic Uses New York and
rbiUdelphia 1899

21 Edited by E. Dietrich and S Karalner Lcipug 1916 1926 5 volumcj

ANfERICAN SPAS

interest, however, lies in general clmiol medicine. Once the science o£
health resorts develops, the need for a forum will undoubtedly be felt.

5. Organization of an American association of health resorts. The re-
sorts Iiave many problems and interests, scientific and economic, in com-
mon. A permanent secretariat would serve as a clearinghouse and could
become a valuable source of information for physicians and public alike.
It would be a distributing agency for literature on the various spas and
could supply information concerning medical facilities available and
costs of treatments.

6. And finally, steps should be taken now to plan for a broadly con-
ceived social program that would make our health resorts available to the
mass of the people and rvould develop them into strong centers of human
conservation. In the reorganization of medical services that is bound to
come after the war, our health resorts can play a very important part.
Thought should be given to the subject in time, and plans should be dis-
cussed with health and welfare authorities, trade unions, farm groups,
and consumers’ organizations.

I am well arvare that this is an ambitious program that cannot be re-
alized over night, but, if ever, it is timely now when the foreign competi-
tion has dropped out and the country must rely on its osm resources.
America is blessed with all curative forces nature can provide. It is up to
us to use them intelligently for the benefit of the people.

SCIENCE AND HISTORY

■««!!>

O far the lectures m this senes have been dealing with various as
pects of modem science as the foundation of modern medicine May I be
allowed to look at science from a somewhat different angle? Science and
history seem to have very little m common Few scientists are interested
in history, and modem science is so absorbing that it leaves little time for
studies in other fields A scientist who formerly was well known once
said to me that he was not interested in studying history because he was
making history He is dead now, and unfortunately very little of his work
has stood the test of time The historian, on the other hand, has a very
scanty knowledge of science, not much more than what he learned in
secondary school And yet the two, science and history, have much more
in common than appears on the surface The sharp division between sci
ence and the humanities is artificial, a late development, the result of
specialization It did not exist in the Renaissance Girolamo Fracastoro
the four hundredth anni> ersary of whose death ivas commemorated
widely in 1953, was a physician to be sure, who made important contn
buttons to our knowledge of contagion and contagious diseases, but he
ivas a humanist first and foremost, who ivrote poetry and whose range of
interests was extraordinarily wide His contemporary Paracelsus v/as a
physiaan also, but he ivrote tlieological and philosophical works And
even in the eighteenth century we do not find that sharp distinction be

SCIENCE AND HISTORY

tw’een science and the humanities. Albrecht von Haller, who was prob-
ably the foremost physiologist of the period, entered the literary scene
with a volume oE poems which exerted a very strong influence on German
literature and in some ^vzys even anticipated Goethe. Besides witing
enormous tomes on botany, anatomy, physiology, besides editing many
works of students and colleagues and svriting innumerable letters on
scientific subjects, Haller also wrote three novels and several theological
books. The great French philosophers of the period o£ enlightenment
■—men like Diderot, d’Alembert, Rousseau, Voltaire— were philosophers,
poets, historians, and were all keenly interested in science.

The great development of the various sciences in the nineteenth and
particularly in the twentieth centuries was responsible for the split be-
tween science and the humanities, and wc are sometimes inclined to
identify the humanities with culture and science with technology, which
is quite wrong. The work of scientists like Dai^vin or Haeckel had greatly
influenced the philosophic outlook of men of my generation. At a con-
ference of the IVorld Health Organization at Nancy in 1952, the general
opinion was that medical students should be cultured, that they should
have a broad humanistic outlook, and one member of our group made
the very pertinent remark that science tvas also culture and that the train-
ing in the sciences that the medical students received was contributing
to the development of such a broad humanistic outlook in them to a very
great extent.

We all know that science has a future, and probably a very great fu-
ture. The progress achieved in the few decades since my graduation from
medical school in 1917 has been stupendous. We are, however, all too
inclined to forget that science also has a past and that today’s progress is
the outcome and result of a very long development. The historian, on the
other hand, is oniy too ready to ioigti tbw is wm. ^ nivt TC.ayat

factors in the molding of history. I should like to discuss the subject of
science and history from two angles. First and foremost I would like to
point out the tremendous significance of the time factor in the develop-
ment of science, and secondly I will say a few words about science as an
element in the making of history.

A poet who urites an elegy, a form of poetry very popular in antiquity,
or a sonnet, a form of poetry brought to great perfection in the Renais-
sance. or a poem in free verse, may have rvritten a very good poem, but it
need not necessarily be better than an elegy of Archilochus or a sonnet
of Petrarch. In other words there is no progress m poetry as there is in

ON THE HISTORY OF MEDICINE

science Within the framework of the society of which he is a member the
poet expresses the fears and hopes the joys and anxieties that he and
many of his contemporaries feel and does it in a given style which is the
style of his period He does not have to build on the accumulated experi
ence of the centuries but the scientist does An observation may be cor
rect but it is wasted if the time is not ripe and the foundations are miss
ing Let me give you a very simple example from the medical literature
of ancient Greece

The Hippocratic physicians observed that in certain cases of bronchitis
you heard a distinctive murmur inside the chest which sounded hhe
boiling vinegar In the case of dry pleurisy they heard something that
sounded as if a new leather strap ivas bent to and fro In other cases of
pleurisy they shook the patient— this method was later to be named
succussio Htppocratts~2.T\d heard a distinct sound In other words the
Greeks in the fifth century b c had found the principle of auscultation
Why did they not develop it? Why did the world liave to wait for Laen
nec before auscultation became a generally accepted method of exami
nation? For the simple reason that the Greeks did not think in terms of
pathological anatomy Since the middle of the eighteenth century tve
have known that many symptoms of disease are the functional expres
Sion of anatomical changes in the organs and therefore methods were
developed so that these changes could be perceii ed with our sense organs
in the living patient In 1761 the Viennese physician Auenbrugger in
vented the method of percussion and it was not by accident that this
invention was made by the son of an innkeeper who used to knock at his
kegs m order to hear whether they were full or empty Nor was it an ac
cident that he was a good musician as was also Laennec because only
people with a good ear were able to discover slight differences m sounds
Auenbrugger s book is a classic and it is interesting to read that he
thought he could find changes in the chest in cases of nostalgia ivhich ive
know to be anything but a pulmonary disease Nostalgia however is an
excellent example showing how medical views are sometimes determined
by outside factors and are time bound
An Alsatian medical student Johannes Hofer wrote a doctoral dis
sertation m 1611 at the University of Basel under the title De Nostalgia
Oder Heimwehe in which he described nostalgia as a disease entity of its
own The dissertation met with immediate success was reprinted and
translated J J Scheuchzer took up the subject and attributed respon
sibility for the disease to the air It was for very good reasons that Swiss

SCIENCE AND HISTORY

physicians were particularly interested in this disease. At that time many
Swiss soldiers were in foreign service, and it happened occasionally that
one of them became so homesick that he deserted. Such a highly dishon-
orable action was resented by the whole nation. If homesickness, hoxv-
ever, were a phj^ical ailment caused by changes of atmospheric pressure
when a mountaineer tvent to live in the lowlands, then there ivas an ex-
cuse for desertion, disease being aUvays considered as an accident which
excused people from many of the obligations under which people in good
health stood.^

Another example of a strange time<onditioned disease is that of
tarantism. It occurred in southern Italy, particularly in Apulia, in the
Middle Ages and the Renaissance, and we have descriptions of it even
from the seventeenth and eighteenth centuries. The disease was attrib-
uted to the sting of a spider, the tarantula. People were attacked by it at
the height of the summer heat, in July and August. They suddenly
jumped up, feeling an acute pain like the sting of a bee. Some saw the
spider; others did not, but they knew it must be the tarantula. They ran
out of the house into the street, to the market place, dancing in great
excitement. Soon they were joined by othen who like them, had just
been bitten or by people who had been slung in previous years, for the
disease remained in the body and was reactivated every year by the heat
of summer. People were known to have relapsed every summer for thirty
years. All ages were affected, children as well as old people, although most
of them were men and women in the prime of life. More women than
men were attacked by the disease. Its victims were mostly peasant people,
but ladies and gentlemen and even worthy monks and nuns were not
spared. People danced wildly in the queerest attire, dressed in strange
costumes svith necklaces, in dresses of bright color, red, green, and yellow,
but they could not endure the sight of black. Some would tear their
clothes and show their nakedness, losing all sense of modesty. They tvaved
red cloths in their hands, -wore meaths of vine leaves and svaved boughs
of vine. Some called for swords and acted like fencers, others for tvhips
and flagellated each other; women called for mirrors and howled, making
indecent motions. Others again liked to be tossed in the air. while still
others rolled in the dirt like swine. They all drank wine plentifully and
acted and talked like drunken people. ^Ve these details to a mono-

, ^ .... , ., 1 ^, Fnti Emsi. Vom fieimweh, Zurich. 19-19. An English

o! Hoi di^raUoo ™ poWistrf i»
c/ Medicine 5:376, 1954.

ON THE HISTORY OF MEDICINE

graph Witten by in outstanding Italian physician, Giorgio Baglivi,
who studied the disease on the spot *

There was only one cure for the disease, and this was music and
dancing Bands of musicians roamed the country at the height of sum
mer playing the tarantella repeating the tunes an endless number of
times until people broke down perspiring profusely, whereupon they
were cured, at least for that year, but the following year the sound of the
tarantella would reactivate the poison that was believed to be in their
system We know the music that was played as the learned Jesuit father
Athanasius Kircher collected the tunes and published them m his work
Magnes stve de Arte ATagnetica, in 1C4I Baglivi, being a good latro-
mechanist, explained the action of the poison mechanically, but as early
as the eighteenth century it was found that the sting of the tarantula was
perfectly harmless or at least not more harmful than the sting of a bee
or a wasp The explanation must be sought m a totally different direc
tion In 1621 a physician, Epiphanius Fcrdinandus put his finger on the
right spot when he said that some people considered the disease mel
anchoUae seu amenttas quaedam speaes, some kind of melancholy or
insanity, and this neurosis becomes understandable when one remembers
that It occurred in a region where orgiastic cults the cults of Dionysus
Cybele Demeter and others were celebrated cults ivhich had a decidedly
erotic character Christianity came late to Apulia and came to a primitive
and conservative population m which ancient beliefs and customs were
deeply rooted The pagan rites so popular with the people were now
considered sinful But they survived nevertheless probably in secret and
one day they came to the light again as symptoms of a disease which not
only excused but legitimized them It is one of many pagan institutions
that survived in the Christian world after having changed meaning
The observation of the Hippocratic physicians of murmurs within the
chest in certain diseased conditions showed that a correct observation
cannot be developed if the time is not yet npe for it If we go back to
the Hippocratic writings we may find however, that observation and
correct reasoning could give good results even if the theory was ivrong
Thus the Greeks knew that pneumonia did not always end m crisis but
that sometimes empyema developed According to the theory, pneumonia

2 Giorgio Baglivi Dtsserlatia de Anatome Monu et EBecUbus Tarantulae written m
1695 published in the various editions ol {lu opera Omnia English translation in the
vanous editions o£ his The PracUce of Phjnck Other literature on tarantism in H E
Sigenst Civilisation and Disease Ithaca N Y 1943

SCIENCE AND HISTORY

\vas a phlegmatic disease; the phlegm became pus which accumulated in
the pleural cavity and had to be driven out through the natural healing
power of the body. The pus svould then cither break through the wall
of the chest or into the bronchi. The Greeks knew that such a process
took a very long time, so long in fact that the patient had a good chance
of dying before die pus had broken through. The physician’s task there-
fore \vas to help nature in its healing tendency, that is, to create an arti-
ficial opening for the pus to break through. The problem, however, svas
to find the pus, and to know where the incision should be made. To us
this is very easy because wc have the method of percussion, sve have
X'lays, and we can make an exploratory puncture. The Greeks did not
have any of these methods, and they had to rely on reasoning. Empyema
tvas an inflammatory disease. Hence heat tvas developed, and the point
of greatest heat must be tlie point where the pus had collected and where
the incision was to be made. But it vw not easy to find that point. Put-
ting the hand on the chest would not have been reliable enough. So they
devised a very simple method, stirred a fine clay in water, and applied
this suspension rapidly to the back of the chest. The point where the clay
dried first obviously was the hottest spot, and there the incision was made.

Aristarchus in the third century d.c. taught at Alexandria that the sun
is at rest, that the earth rotates about its osvn axis, and that the earth
like other planets circles around the sun. Today we know that he svas
right, but the time u'as not ripe for his discovery. Nobody believed him;
he svas charged with impiety, and the geocentric system of Vtoiemy domi-
nated astronomical theories until the time of Copernicus.

Another example which I think illustrates very graphically the im-
portance of the time clement in science is to be found in the work of the
German anatomist and pathologist Jakob Henle. In 1840 he published a
remarkable book on pathological investigations, the first part of which
discusses miasmas and contagium and miasmatic-contagious diseases. He
demonstrates that miasma is a substance which enters the human body
from the outside svorld and causes disease. The prototype of such a dis-
ease is malaria, which is always acquired from outside and not by contact.

A contagium on the other hand is produced in the body and is trans-
mitted from one individual to another. The prototype of such a disease
is syphilis, which is transmitted by contact. Most other infectious dis-
eases, however, are miasmatic-conta^otis. An individual acquires a
miasma from outside, develops a contagium which then is passed on from
one to the other. Such a disease is the phgue. One gets jt from outside

ON THE HISTORY OF MEDICINE

through a miasma which then multiplies m the body and is passed on to
large numbers of individuals If, however, miasma and contagium can
produce the same disease they must be identical, and must be not only
organic but live material which develops in the body like a parasite
Henle s treatise was a masterpiece of logic and was correct m all its basic
assumptions, yet there was no response to it Why? Again due to the
time element In 1840 German medicine was just liberating itself from
the lofty speculations of Naturphtlosophte, and people ivanted to see
things and not merely believe in them Twenty years later, Pasteur and
Robert Koch were able to show under the microscope ivhat the miasmas
and contagiums actually were and thus satisfy the inquisitive spirit of a
rationalist age

In 1928 the tercentenary of the publication of William Harvey s book
describing the circulation of the blood was commemorated all over the
world I was at the University of Leipzig at the time- and was asked to
give a formal address on the occasion I did not want to repeat what had
been so aptly said many times before, that Harvey was a brilliant investi
gator— there had been many others before and after him— that he made
the experimental method one of the chief methods of research m biology,
that he very successfully applied quantitative considerations Expen
ments had been performed before Harvey, and one of his contemporaries
Santono Santorio tried to solve another biological problem quantita
lively, the problem of metabolism To that end he spent part of his life
on scales weighing carefully what entered and what left his body, but the
problem was one that could not be solved before the revolution in chem
istry brought about by Lavoisier It puzzled me to know why the circula
tion of the blood was discovered m the first half of the seventeenth
century, why not before, why not later? There were many brilliant anat
omists in the sixteenth century, and even before that time the lesser
circulation had been seen incidentally by some and described, although
Its full significance was not recognized If we wish to understand cor
rectly a ne%v scientific development, we must study it within the frame
work of the general civilization of the period, studying that civilization
m all its aspects economic, social literary, artistic, etc When we do this
in the case of Harvey we soon find that at the end of the sixteenth cen
tury and in the early seventeenth century a basic change took place in
mans outlook on the world The relation between the individual and
the world changed, and he looked at it svith different eyes A new art
developed with Michelangelo— an art which matured in the seventeenth

SCIENCE AND HISTORY

century and which we call the art of the baroque as compared with the
classical art of the Renaissance. If one compares a baroque painting,
sculpture, or building rv'ith classical works of art, one finds significant
differences. The painter of the Renaissance painted his figures with clear
outlines, well-defined surfaces; his composition was harmonious and well
balanced. The baroque artist, on the other hand, saw the world in mo-
tion; the outlines of his figures were erased, played upon by light and
shadow. He emphasized the diagonal in his compositions; an open win-
dow’, a distant landscape may catch your e)’e, and this gave his creation
depth and wider perspective. His art was dynamic, not static. The Ren-
aissance artist was interested in what exists, the baroque artist in what
happens. There tvas a definite change from a static to a dynamic out-
look, one which we find not only in art, but in music beginning with
Caccini, in physics with Galileo, and in the medical sciences with Harv’ey.
He was an anatomist, as we all know, but what fascinated him was mo-
tion, and in his hands anatomy became anatomia onimaCa. Harvey wote
another book which characteristically enough had embryology for a
subject. Embryology also is dynamic anatomy, one that changes from one
moment to another.

Every science requires a foundation upon which to build. There could
be no scientific physiology without anatomy, and today physiology has
to draw heavily from the discoveries made in physics and chemistry.
The example of Harvey shows that a scientific movement can only de-
velop in a certain atmosphere. It follows the general trends of the period,
and it is perfectly obvious that the social and economic conditions pre-
vailing at that time must have a strong influence on the development of
science, acting either as a stimulus and incentive or as a retarding factor.
Ancient Greece was a seafaring nation, and as soon as their ships went be-
yond the Aegean sea some astronomical knotvledge was required, which
in turn called for mathematics. Throughout history navigation has been
a strong stimulus to science. The larger the ships became the further they
went, and the more scientific knowledge was required.

Slave economy, on the other hand, -was a handicap to science. As long
as slave labor was easily available and cheap there was no demand for
labor-saving machines. The Greeks knew the principle of the steam
engine but never applied it. There svas no need for vastly increased in-
dustrial production in a society which consisted for the most part of
slaves, small farmers, and craftsmen. Handicraft industry was perfectly
sufficient to satisfy the needs of a small upper class. The very ingenious

ON THE HISTORY OF MEDICINE

machines described by Hero of Alexandria remained to a large extent on
paper Conditions changed when the Roman Empire was pacified and
slaves became rarer and more expensive, and even more so when slavery
was abolished altogether m Christian Europe There was a great shortage
of labor m the Middle Ages and as a result great efforts were made to
make better use of animal power, water power, and wind power

In the Renaissance the demand for metals increased considerably An
increased volume of trade required more gold as a medium of exchange
and voyages of discovery were launched in search of gold It was found
m Mexico in Peru and the early expeditions to North America were also
undertaken in the search for gold The new firearms demanded more
copper and lead and since the shallow deposits of minerals were ex
hausted new machinery was required and new health hazards created
It is not by accident that the first monographs on occupational diseases
and particularly on miners diseases were wrritten at that time

Men of my generation have experienced two world wars Both brought
endless destruction and suffering to the world but we cannot deny that
they were also a strong stimulus to science We remember what aviation
was before World War I and how tremendously it developed during and
after the war The second World War brought radar the use of atomic
energy and speed m the application of the sulfa drugs penicillin and
DDT which would have been quite impossible without the pressure of
war War means destruction But it is no fault of the scientists if their
discoveries are used for destructive purposes It is the fault of the people
who have not yet learned to create the social organization that the new
science requires The New Yorker, that greatest of all American maga
zines printed a highly significant cartoon a few years ago A young man
was telling his parents that he wanted to become a scientist whereupon
one of the parents terrified said Isn t there enough trouble m the
world already? How far have we moved from the hopes of the eighteenth
and nineteenth centuries when it was assumed that science would be the
means of liberating the people once and for all from the bonds of disease
hunger and poverty?

The time element also noticeably affects the speed with which a dis
covery is accepted Auenbruggers percussion was a most valuable inven
tion as It gave the physician an extremely useful diagnostic method but
hardly any notice was taken of it at the time his book was published and
almost half a century passed before the method was seriously discussed
and then gradually accepted The authority of Corvisart physician m

SCIENCE AND HISTORY

ordinary to Napoleon, ivas needed to draw general attention to percus-
sion. In 1808 he published a new edition of Auenbrugger’s book with
a French translation and a voluminous commentary, and from then on
physicians began to practice percussion, in France first, then in England,
and finally also in Auenhrugger’s home land, Austria, and in Germany.
The explanation for this delayed recognition is easy to find. The year
1761 not only saw the publication of Auenbrugger’s book but also of
Morgagni’s great work De Sedibus et Cousis Morborum per Analomen
indagatis, a book which was to become the foundation of pathological
anatomy. Anatomical thinking rvas not yet general enough to ■warrant
the acceptance of percussion.

In tlte seventeenth century Santorio constructed a thermometer to
measure the temperature of patients suffering from fever. It -was a glass
ball that the patient kept in his mouth, connected with a tube on which
the temperature could be read. But at that time nobody thought of meas-
uring fever, and for centuries physicians believed that putting the hand
on the patient’s forehead tvas enough to determine a sick man's fever,
although Boerhaave in the early eighteenth century and de Haen some
time later had used the thermometer in their clinics at Leiden and
Vienna. The measuring of temperature as a matter of routine became
general only in the second half of the nineteenth century. On the other
hand, the discovery of the X-ray spread like ^vildfire. I ^rill give you a
fetv dates for France only, but I am sure they 'were very similar in other
countries. On December 28, 1895, Wilhelm Roentgen announced his
discovery. A few weeks later, on February 10. 1896, Charles Henry pre-
sented a report on Roentgen's discovery to the French Academy of Sci-
ence. On April 17 the fint French X-ray machines were sho^vn. Before
that, on April 1 a clinical demonstration svas made before the Socidt^
de Chirurgie and on August 6 before the Congr^s Fnin^ais de MWeeine.*
Why such a difference in the acceptance of thermometry and of the
X-ray? Again the reason is not difficult to find. Little was knosvn about
the physiology of fever before the nineteenth century, and it took the
physicians some time to think about it in quantitative terms. The use of
X-rays for purposes of diagnosis, however, ivas on the straight line of
medical development and svas the crovming method which had been pre-
ceded by percussion, auscultation, the invention of the ophthalmoscope
and of the laryngoscope, by apparatuses that introduced electric bulbs
and mirrors into every cavity of the body in an attempt to see anatomical
8H. Pfquignot, “La mMedne « le moode modeme," Let Temps Moderrses 9:T!3. l9o3.

ON THE HISTORY OF MEDICINE

changes in the living organisms The X ray, which permitted one to look
through the body, rvas eagerly accepted in a very short time A factor
which must be kept in mind also is that Roentgen never took a patent
on his discovery, but even if he had the method would have been adopted
without delay

The time factor plays a part in another sense, and to illustrate this I
would like to go back to Paracelsus and to one of his most inspiring
books, the Volumen Paramtntm, a book on which he worked for many
years and which he completed around 1530* The book is not easy to
read as it is written in the symbolic terms so dear to the author, but it is
undoubtedly the ripest fruit of Paracelsus thought It is an attempt to
outline a medical anthropology Five spheres five entities determine
man s life m health and disease The first is ens astrale, of which I shall
have more to say in a moment The second is ens veneni Man is part of
nature he lives in a physical environment from which he derives matter
and energy Food comes from nature but so does poison there arc
normal but also abnormal stimulations Everything that comes from
nature is both good and evil food is good poison is evil but poison may
also be a remedy It is the dosage that determines the effect The third
sphere is ens naturale Men may be contemporaries but no two are
identical and we know well enough that no two individuals have the
same fingerprint or the same handwriting Every individual is bom with
a nature of his own and to a large extent carries his destiny within him
self The fourth sphere is ens spirituale Man has body and mind like all
other animals they are one inasmuch as they determine one another mu
tually But man is an animal of a special kind He is conscious of himself
and of his past he not only feels pain but is able to reflect about the phe
nomenon of pam and to establish abstract concepts Thus the spirit m
Paracelsus terminology gives man a special position m nature and from
the spirit causes of disease may also arise
Now let us go back to the first entity What is ens astrale^ The stars
move according to eternal laws and so does man s life The constellation
characterizes a given moment and every individual has his moment his
historical time which affects his life in health and disease This is a very
fine and correct thought Thirty years ago I had an ordinary pneumococ
cus pneumonia which developed into an empyema and I was ill for
many months Today the same pneumonia would have been cured m

<An English iranslaiion by K F Leidcckerivaj published as Supplement No 11 to Bui
letin of the lltslory of Medicine Baltimore 1949

SCIENCE AND HISTORY

a few days and the empyema avoided. People suffering from pernicious
anemia, diabetes, meningitis, erysipelas, pxierperal fever, and many other
diseases have good chances for survis'al today, xvhile they were lost only
yesterday. On the other hand, men of my generation had good chances
of being killed in two xvars. The historical moment, in other words, af-
fects not only scienttffc des'clopments, but also man’s health and illness.

Let me make just a few remarks about science as a factor in the molding
of history. I shall be brief because the facts are more generally knotvm,
and I shall limit myself to the impact of science on society and to a few
recent developments in the western world. As long as agriculture was
primitive and industry consisted of craftsmen operating on a small scale,
little science stos needed and applied in (he process of production. From
the Renaissance onwards, however, scientific thought and scientific dis-
coveries began to exert an cver-inacasing influence. The voyages of dis-
covery in the sixteenth century made a deep impression on western
society; new continents were found with plants, animals, and races of
mankind unknown to the Greeks. The human body svas explored by
Vesalius and his fellow anatomists, and the universe by Copernicus and
his followers. This discovery of the tvorld broadened man’s outlook con-
siderably, and it tvas continued in the eighteenth century by Newton,
Galileo, Kepler, and many others. At the same time, Harvey, Descartes,
Borelli showed that the human body was some kind of a mechanical sys-
tem and that mechanical laws applied to it also. The microscope revealed
a world of infinitely small living beings. One discovery followed another.
In the eighteenth century it was electricity. Chemistry had its great rev-
olution, and the steam engine tvas invented. The philosophers deeply
interested in science became its chief popularizers and propagandists.
The French Revolution enthroned reason, and reason is the essence of
science.

In the course of the nineteenth century, in Europe first, in America
somewhat later, science became a determining factor in history. New in-
dustries developed, and industrial output both increased considerably in
quantity and improved in quality. The populations of all industrial
countries increased because nexv means of transportation made it possible
to bring food from distant regions and the population could grow beyond
the capacity of the home soil. At the end of the Iasi and m the beginning

ON THE HISTORY OF MEDICINE

of our own century, science created new industnes directly, such as the
electrical, the chemical, the food and cosmetics industries, and a second
industrial revolution took place which affected the western world as
strongly as the first The splitting of the atom may well inaugurate a
third industrial revolution, and let us hope that it will be for the benefit
and not for the destruction of mankind

The industrialization of the West created a new social and economic
order The majority of people became tvage earners or salaried employees
who depended for their living on the labor market, over which they had
no control The working class organized itself m militant trade unions
and political parties The polarization of society to the right and to the
left IS a process m the midst of which we still find ourselves today The
industrialization of the West also created a new political outlook Sources
of raw material were needed to feed the industries and foreign markets
to absorb their products, thus leading e\ery western country to endeavor
to build a colonial empire

In the field of biology Danvin’s theory of evolution had a profound in
fluence upon philosophic and religious thought, so much so that its teach
ing IS still forbidden in parts of America As a result of science, the general
rnaierial standard of living was raised, at least m some western countries
Life has become safer, more comfortable, and we have an infinity of en
joyable gadgets Science is worshipped, and there is no better recom
mendation for a toothpaste or breakfast cereal than to advertise it as
being scientific A man like Einstein is universally respected although
very few people understand what his contribution to science has been
But he IS highly esteemed as the embodiment and symbol of science

Science, however, also knows of many frustrations Industries apply
scientific principles to their production, to be sure, but by no means
freely We all know of the endless number of patents that are purchased
by firms in order to be suppressed, in order to forestall competition or
because a firm wants to use up its old machinery Governments do not
act scientifically They consult with scientists obviously— hundreds or
even thousands of scientists are in the government service as experts, and
m the United States the Department of Agriculture is one of the foremost
scientific research institutions of the country But politics are the result
of compromise conflicts of vested interests are unavoidable Foreign
policy IS still less scientific If we could exploit the resources of the world
scientifically, if production, distribution, and consumption could be or
ganized along scientific lines, the standard of living would be raised con

SCIENCE AND HISTORY

siderably. But we all know how difficult this problem is. Socialism is an
attempt to organize the life of a nation in a scientific manner, and tve
shall have to see hotv successful it rvill be.

^Vhen, thirty years ago, some of us talked of the social implications of
science, nobody listened. In the current textbooks of history, the rvord
science s\ras as a rule not even mentioned. The situation has changed
today, and rve have many excellent textbooks of all grades rvhich fully
recognize the great part played by science in the historical development
of the western Avorld. The scientist, on the other hand, is beginning to be
aware of his social responsibilities. He is not only an expert but has an
important part to play as an expert citizen.

The history of science can teach us a great deal. In our schools science
is too frequently taught in a dogmatic rvay and not presented in its
cultural setting. A body of generally accepted knowledge, simplified and
carefully digested, is transmitted to students who accept it as a matter of
couree. The graduate teaching of science trains specialists, highly efficient
specialists, who, however, are frequently uneducated outside their spe*
cialty. The academic world surrendered so readily to dictatorship in
many countries because it consisted of specialists who knew nothing out*
side the narrow bounds of their special field. If we wish to produce a
citizen able to think in terms of science and a scientist prepared to partici-
pate in social action, we must improve our methods of teaching. One
>vay, and in my opinion it holds great promise, is to approach the sci-
ences not only technically but also historically, philosophically, and
sociologically.

ANCIENT AND MEDIEVAL MEDICINE

ON THE HISTORY OF MEDICINE

speed unknown heretofore The Hippocratic chair died a natural death
The time had come to look upon Hippocrates not as a demigod but as a
fifth century b c Greek physician to look at the Corpus Hippocraticum
not as on a book of revelations but as on a literary expression of fifth
century Greece

Emile Littr^ entered the scene Applying the critical methods of classi
cal philology, studying all the manuscripts known at the time, he en
dea\ored to restore the original text Translating it into French, he
interpreted it And in a series of splendid essays introducing the different
treatises he ivrote in a most scholarly way as many dissertations on the
manifold and intricate problems of the Corpus Hippocraticum

In this way Emile Littrd created a definite picture of Hippocrates and
Hippocratic medicine that has entered the textbooks and is well knoivn
to all who are familiar with the history of medicine
The work initiated by Littr6 didn t stop Much has since been written
on Hippocrates and the Corpus Right in our day we can witness a revival
of interest in these problems I thought that it might interest the readers
of this bulletin to hear what has been done on the subject in the last few
years, how far our picture of Hippocratic medicine has been changed,
what the present status of the problem is

Who was Hippocrates? A well known physician, teacher of the healing
art an Asklepnd born in Cos, who lived towards the end of the fifth
century and in the first half of the fourth century n c This is all we know
from contemporary sources, two passages in the Dialogues of Plato (Protag
oras 311 b Phaidros 270 c)* Centuries later, when Hippocrates occu
pied a central position in Greek medicine, legends arose around his name
which, like many legends may Ime had a certain foundation, may have
been the final expression of old traditions As long however, as we have
no authentic documents we will have to accept the legends for what they
arc ithout attributing to them any biographical value ®

Considering this very regrettable lack of sources, we eagerly aivaitcd

iTo ^hich we may e%cnlually have to aid an Imenplion in Delphi Tomtov Il.ppok
rain und »1 e Aiklepiaden m Delphi - hbo IS 141 R. Henog Dat delphluhe Orakel alt
ethUcher Preurichicr- in E llorneller Drr junge Plalo vol I 1922 p 1G4
8Two papen on ihe legends concerning Hippocrates are bang prepared by a inanber
of our institute and will be published in later bsuci of thb bulletin fBu//c/m of the
Hltlory of Jlfcdinne]

ON HIPPOCRATES

the tcsults of the German excavations carried out on the island of Cos
hoping that they svould throw nerv light on Hippocrates and his activities.’
They did not, interesting as they arc.» They proved that, contrary to the
traditions, the cult of Asklepios was not brougitt to Cos before the middle
of the fourth century n.c,, that is to say, after the death of Hippocrates.
The first altar was erected lo Asklepios shortly after 350 n.c., and the
temple built in tiie beginning of the third century. All the stories about
Hippocrates and his relations with the Asklepieion, therefore, have to
be banished into tile realm of imagination. And this is probably true of
the other stories as tvell.

The German excavations, however, brought to light more than twenty
inscriptions concerning physicians, giving evidence of the flourishing
condition of the medical school of Cos in the third and second centuries
B.C., and of its relation to the Asklepieion. Rudolf Herzog believes that
an inscription that he found should be considered as the sepulchral in-
scription of Thessalus, son of Hippocrates.*

We still know very little about Hippocrates. And yet, like the physi-
cians of imperial Rome, the doctors of our days want to know all about
the life of the fatlier of medicine. Where there are no historical sources
available, imagination will step in and the poet will replace the historian,

In 1923 Georg Sticker published a German translation of books I and
in of the Epidemics, with an excellent medical commentary.® In the in-
troduction he traced a picture of Hippcxrrates. Assuming that all the
Hippocratic ivritings, in spite of all contradictions, were tvritten by the
same man— Hippocrates himself— he wrote a kind of fairy tale, charming
in its naiVeti, but having nothing ivhatever to do with Hippocrates.

The same is true of another much more pretentious publication. It is
rare to find an inaugural dissertation on a best-seller s list. And yet this
happened in the case of Gaston Baissette's Hippoctale.^ It was translated
into German, » into Italian (1933), and an English translation probably

Henos HeiUge Cesette von Kos, Abhandlungcn der Preussischen Akademie det
Wissenschaften. Phil.-Hbt. Klassc. nr. 6, 1928; fVunderheilungen i«n Epidauros, Leipzig.
195t; Kos, vol. I, Berlin. 1932. These very imporant books will be rev«eH«d jn a later
anicle on medical archeology. , ~ .

<"Die Grabschrift des Thessalos von Kos." Quells und Studien itir Gesehiehte der
NatUTviisensehaflen und der Mediiin (Berlin) S{4):54-58. 193S.

e Hlppolcrates. Der VoUukrankheHen erstes tind dnUes Buth (um das Jahr v-

Chr.), aus dera Griechischen flberseat, eingddtet und erlauiert. Klassiker der Median.
Vol. 28, Leipzig, 1923.

* Paris, 1931, Bernard Grasset.

' Ubn md Uhre dri Hifpotnu,, Swltgan. Ldpus, 1932.

100

ON THE HISTORY OF MEDICINE

will be unavoidable A brilliantly wntten book, a ‘ biographic romanc^e,"
a product of the ‘ biographical industry ” Doctors who are tired of read
mg detective stories before going to sleep will revel in reading this book
The author has collected whatever has been written on Hippocrates in
the last 2000 years and has read Lattri s translation carefully With this
material in hand he has created a powerful story, a great picture of what
an ancient doctor could have been Why not? There is no harm in it as
long as we are aware that we are reading fiction and not history On the
cover of the book the stoic philosopher Chrysippus is represented after
the well known bust of the British Museum, which was formerly believed
to be Hippocrates We are glad to hear that the author's next two books
will be real novels and we certainly admire the liberality and the literary
taste of the medical faculty that accepted this book as an inaugural dis
sertation

f we want to know what Hippocratic medicine was like, we have to
.onsult the Corpus Hippocraticum The best complete edition still is
Littr^s edition* Good as it is, it certainly has very serious deficiencies
It was a first attempt at a critical edition, and as such is necessarily im
perfect Littri based his text almost exclusively on the Pans manuscripts
But there are other very important manuscripts extant which are very
helpful m elucidating obscure passages It was to be expected therefore
that new editions based on a broader manuscript foundation would be
attempted The most important of these undoubtedly was the edition of
Ilberg and Kuhlewein,® who succeeded in improving Littr6 s text m
many respects, but unfortunately never completing their work A first
issued in 1894, a second followed eight years later in 1902,
A publication stopped It stopped because in the meantime

Uie Academic Union, under the leadership of Hermann Diels and the
Prussian Academy, had decided on the publication of the Corpus Medi
corum Graecorura, a collection that was to include critical editions of all
Greek medical texts that have come down to us One of the most im
portant items of the collection, naturally, was to be a new complete edi
tion of the Corpus Hippocraticum

NouvfUc avec le Crcc en regard

,parE.Liitri Paris 1839 1861 lOvolumw

St o™”" n* H Kutbfcwtio (Ptol^tob on

icripseninl 1 Ilberg cl H Kuehicwcin) Leipzig 1894 1902 2 volumes

ON HIPPOCRATES

101

on. recogn^cd .ha. U.e

source for .he rccons.ruC.on of ,„„Ues, The oldes.

„en.aries .ha. Galen '™‘= ° in .he .en.h cen-

manuscripo of H.ppoaates .h usciipts were tha. Galen used,

.ury A.U. We do no. know '--“^“an ours, and .herefore much
bu. in any case .hey were 8 y considered very

nearer .o .he originals, so .ha. Galen s texr

carefully. t j overcome, because there ^vas

Bu. here enormous a'la"''.!^ ^ We are s.ill

no crhical edi.ion of “^i. c^ and even worse

using Kuhn's edi.ion,'” which 8 approach

.ban some of .he Renaissance pr • Oalen's commen.aries by

five years and , Hippocm.es was published m .he

Finally, in 1927, a firs, volume ,vord in H.ppo-

Corpus Mcdiconim Gn>«o™"’; , jisapproval among philolo-

era.ic T^xi-KrUik. bu. .. ''•■‘‘X, been consuUed. The emenda.-

cists. One important manuscript a text, were

fnghand. the genial "\holtr who did splendid

missed. Heiberg s«s a Bu. he was old and ^

field of Greek science and medic publication of the book,

wked on Hippocrases. «= died s^re n"ors .ha. h will be desmoyed
L'’a\:r.‘^G;d when ...e corpus will produce i.

.he mean.ime, .he

,0 Ctaaii ermi op™ O”""- "'X Cxae^nim. -ol.

n„,pp.™..., sd. I. n. Hobsis. com „,n,.

Berlin. 1927. , t„n»Ution by W-H.S J

li Hippocrates. igls-lMI, 4 volamo.

ington). London, New V .

102

ON THE HISTORY OF MEDICINE

P'“" ‘he editors endeavored to

Ll own judX‘t S‘""S the reader a chance to fon.

concerned ^ ‘h^ Corpus Hippocraticum is

Greek oriainal "n°'^n'i’'“ "''''><t''er wants to study Hippocrates in the
comulurr, r “ -d Kuhletvein

sTnTe ‘ r “d Jones A tar

of fhosfrSrof e" ““ c”' separately, and the student

editions mention monographic editions ” All the newer

-there;::rei.d,::rb:rt7Lt/“”"^®^^

edmtn har^ralyre^thTdforu imminence of the Corpus
many years Rin nr ^ prospective Hippocrates editors for

of S„di7„ A”" aim I wish that the editors

Hipp:cs:s“ h:::Xam ^

the htstorians at Urge 7d"'to'th Philologists but also to

always be accompanted hv a . i °ther disciplines should

better than .tremor, „h7h“jr -h° co.tld trLslate a text
fleeted about the meanine of »v 'he weight of every word re

the Corpus Mcd.corura Graeco^m'd"""^ ‘'Sf^'^hle that

cost of printing would have bee 7” ‘tidude translations The

the sale would have been7o mTbT“'"“'”>’ “> h<t h“'

pensated the cost Important hAAl 7” "asily have com

never been comple.eTy

conceptions we have of Galen and h ’’ ‘"f'*™ language The wrong
that, svith the exception of a f '* chiefly to the fact

been translated Galen’s work has not as yet

excellent translation «'conta®7Th™T hltPPnerates for the

contains These four volumes, handy m format,

^ c u„sr , ...

latefimchen Uebtrseiiung heniisw«bCTi

nippocralu Quae Ftnintur Etiitulae ad ^ C«ndennann Bonn 1911 G Putzger
Nelson Die Ilippokralische Schnft *"!!? Wunen 1914 Axel

y‘ nsci «Fio<inr Uppula 1909

ON HIPPOCRATES

103

handsomely printed, and well presented, ought to be in the library o£
every medical man. But just because such excellent work rvas done, I
deplore the more tliat only parts of the Corpus Hippocraticum have been
included in this edition. The treatises omitted, of which the more im*
portant are the Epidemics II, IV-VII, the four books on diseases, and the
gynecological writings, may be of less value, but the student of jnedkai
history cannot overlook them. They may not be of Coan origin, but they
are important documents of Greek medicine as svell as the others.

This omission is particularly serious because the translation of Francis
Adams,** the only other translation available to English readers, is also
not complete. Adams translated only those works which he considered
genuine. Large and certainly not unimportant parts of the Hippocratic
collection therefore are not available in the English language, and this
gap is strongly felt by all those who are teaching medical history to medi-
cal students and are endeavoring to have them read the sources at least
in English translations.

I wish that the editors of the Loeb Classical Library would reconsider
their decision. Two more volumes would complete the work and make
an excellent job still better. A more deuiled index would also greatly
improve the usefulness of a translation which is often consulted for refer-
ence by medical students.

A good German translation of Hippocrates has also been wanted for a
long time. There are a few old translations that are not so bad, the best
of them being probably the one by Grimm.*® It is difficult to find today
and, of course, is obsolete in many respects. A more recent attempt svas
not very successful.** The translator, Robert Fuchs, a philologist, had
the unfortunate idea of translating the ancient text into a modern
pseudomedical technical language which he hardly understood himself.
Concepts of modem medicine were smuggled into the ancient witings,
and the result was an entirely disfigured picture.

And yet in postwar German medicine Hippocrates was in great favor
for reasons that we will discuss in the last paragraph. A new translation
was badly tvanted by the medical profession and tvas considered very
seriously several times. However, it seemed frivolous to start such an

UThe Genuine Works of Hippocrates, mwlated from the Gr«I: with a'pTeliajin^
dueotine and annotatione by Adam*. Utndon. 1849. 2 I

Hippocrates, Werke, Vberseaung von J. F. C. Cnmm.Glogau 1857-1839. 2
itHi^oerates, SSmmiliche Werke, Cbcnetzung too Robert Fuchs. Miinchen. 1895-1900,
5 volumes.

ON THE HISTORY OF MEDICINE

undertiking just before the appearance of the new Corpus edition One
tvailed therefore One tvaited, and nothing was done To complj ^\ith
the demand of the medical public, se\eral anthologies tvere published
of rather problematic value ” Had they been perfect they wouldn’t have
given what was really required— a complete German Hippocrates It was
finally realized that, should the present generation obtain the translation
It W'as asking for, one couldn’t possibly wait very much longer Better a
Hippocrates w ith imperfections than none at all It was good news to hear
tint the long sought translation Ind materialized and would be issued
within a few >cars, although the publisher’s announcement docs not
look very promising”

France has its Littr^, which has become a classic The translation has
deficiencies but is still a monumenuil piece of work that will not soon
be supplanted The original Litir6 was published in ten volumes and.
although still obtainable, is becoming quite expensive To reprint a
tcvis ct ition of the translation was certainly an excellent idea, and the
announcement last )ear ssas generally sselcoraed
In the meantime tuo of the announced volumes Iiave appeared >’ It is
hard to reeogmre the old L.ttri, dear to all of us The nesr edition is
apparently not intended for study but as an ornament of the doctor’s
•I * ** P*'*^’* ‘H the cheap, pretentious pseudobibliophihc manner
hat hccamc so popular after the arar Professor H Roger, the aeneiatcd
can o the Medical Taailty of Pans, avrole a preface and in
They are svarml) amtten and en
linn w” *^0”^ >n the field during the last

II ' V ^ translation Ins been revised but by no means cnti
call) None of the mo<lcm editions of the Greek text Inv e been consulted

1 cDiio t*” ricvs 1 mr^, however, IS the illustrations A bibliophihc

lion obv lousl) has to be illustnted After all, it could have been done,

the Ililf Au MJerte Hufh liLl puW»h«J

I 9 J 0 Cbenetning \r>n Gerhard Jacoby,

£1":;

ON HIPPOCRATES

by reproducing havf preS” to have new

CoLresp'lU niade J the I

series o£ colored pictures that their hut-

display o£ Greek chorus gir • » and as an album

l"ipp"tttMndmedi^^

strongly advue - I^Ut
b"X « 'Ss Hauteleuille, Paris, on ordinary paper-

and is not illustrated.

We do not know which, i£ P^lln

written by Hippocrates h.msd£^Whothe^^ H.ppocratm

^b-ySnl, rttrpmctical achievemenui What diseases were ey
and many other Pt^d^^Thr^ - ml 1

Srldical content of the literature, deeply rooted

”tireHippocraticj^;«f"^^^^

^rgsirt^^^ o; 7f:

numerous P^P- s.- ^

tOMtigil Gumann, P « " jk red“>"<™8'-

Corpus Li ihr, ntatv-ve <“’'

106

ON THE HISTORY OF MEDICINE

treatises Max Wellmann=» atinbutes acxatt]; l^tGixri? {On Ancient
Medicine) to a Pythagorean physician, follower of Alkrmion The
apxaioi laTQol, to whom the author refers m Ins oration as the

founders of medicine, are the Pythagoreans whom he attempts to defend
agamst the dietetic views of the Cnidian school In a short note dealing
with the same treatise Karl Deichgraber" succeeded m improung the
text by suggesting the reading (cap 9. p 41. 21 Heiberg) of roii acofiaw;
rnv la^soiv instead of roij ocDpato; ttjv oTo^oiv, a conjecture ^vhich seems
very good to me

Two important monographs have been svritten on rrepl d^ptav WaTwv
tW (On ^irs. Waters, Places) by two young philologists, Luduig Edel
stem and Hans Diller Dtller’s is a thorough study on the history of the
text, discussing the Greek manuscripts the Latin translations, the oriental
tradmon Galen's commentary on this treatise seas lost in the Greek origi
nal hut preserved in the Hebrew translation Diller gives a critical edi
tion«^ ^ X translation and adds numerous \aluable sugges

crmcareJf ‘he Greek text, of which he promises a new

content T ‘he n>ed>cal and anthropologial

content are also to follow ^

makml”pv?H* He starts by giving a careful analysis,

which Lv ^ consists of two entirely different treattses

rnthtonlrnrA""'“'a"7^ “P ' 2 24, betng a comparauve

a oromott,?^ ‘h'‘°‘her. cap 1 II, is considered

known to him^h^n*^^ instructing the physician who comes to a region un
from them as to t'h ° surroundings and to draw conclusions

tha”he ^av knn uT" P'-'^'hng m such a place, so

ttons Edelstein hll^ ^ ' * n' P‘“‘'““ "Bl't away without asking ques

but that can 1 0 '*"* ‘ceatisc is not homogeneous either,

treat se atT's "“ecpolated from an othenvise lost

EdeTstem s 1"“'’’ " him unrestrictedly

chaptero h , h Z"”" "'2* “ '‘ighly ongmal, and thts first

^ttous on Hin°°““”' ‘he starting point 10 ^ ver; important .nvest.

PP a 1C prognostic the Hippocratic physician, and the

GwcStcAlettcrAtfaii,nrr 299*305‘'iMO*^"*** es**”!! "Ull dpxain; lareixiit Archiv /Sr
!iLSw.e'Md.lt" Ho-mo «S 356 358 I9SS

Ttav «..l»I»sv.,SvppIo„en.b,„d:lxin »o‘'’S “"riS"''

ON HIPPOCRATES

107

Hippocratic question as a whole, to which I will have to return in the
next paragraph.

^ Geographic observations and conceptions in the Hippocratic collec-
tions are the subject of a dissertation by Gerhard Jacoby.^®

The famous treatise tieqX voiaou (On Epilepsy) has recently been
the subject of ttvo papers. Max Wellman*® attributes the treatise to a
physician who belonged to the school of Kroton, or to the Old Cnidian
school, which was very closely connected with Kroton. The author, ac-
cording to Wellmann, tvas a follower of Alkmaion, who reproduced his
master’s vietvs on the physiology of the brain. He svrote this treatise in
his youth, and later, after having traveled all over the world, tvrote axel
dipcDv. In opposition to Wilaraotvitz and Regenbogen, ^Vellmann assumes
that the chapters 14-17 are not interpolated but are an integral part of
the book, a conclusion that was shared by Owsei Temkin.** Temkin gives
a very thorough philological and medical analysis of the treatise and
shows that it was ^vTitten by a physician for laymen. The purpose was to
enlighten people as to the nature of epilepsy, to demonstrate that this
disease ^va.s not more sacred than any other disease, that it u-as curable
by drugs and especially by diet, but that the treatment had to begin early.
Temkin did not restrict himself to this one treatise but examined all
passages of the Corpus on epilepsy and in this way succeeded in giving a
comprehensive picture of what the Hippocratic ph^'sicians knew and
thought about the disease— what they called it and how they treated it.

Among the many Hippocratic rvritings, the Aphorisms undoubtedly
became by far the most popular books; printed, translated, and com-
mented upon endless times, they were the doctor's bible for many cen-
turies and often referred to by the laymen. But tliis popularity tvas
acquired relatively late. Ernst Nachmanson*® searched the nonmedical an-
cient literature for references to the Aphorisms and found remarkably
little.

That the Aphorisms still have a strong appeal to the philosophically
minded physician, that they still provide food for reflection, becomes

SSCerbard Jacoby. Gfographisthe Beobaehtvnsm und Amchauungen im Corpus I/ip-
f ocratjcum, Inaue.-Dbsertalion, Jena, 1925. . _ . . .

2« Max Wellmann, •'Die Schrift jrejjl w5<wv d® Corpus Hippoaaliarm. Archiv
far GtfchMUdtrMfditm 22: S90-3J2. 1X9. - » „

2T0w«i Temkin. TTie Doctrine of EpilepsT HippomUc

the Institute of the History of MediAne (The J?*!”

Ceschiehle der Naiurwisseitseha/ien und _j ‘siudien xur

28 Ernst Nachmanson. -Zum Nacbleben der Aphorifflo." Huellert und Studien xur

108 ON THE HISTORY OF MEDICINE

evident from several papers of Richard Koch” in which lie endeavors
to interpret the fint three Aphorisms and reflects about the causes of the
fame of the Aphorisms in various periods of history.

Since P^trequin s classical book on Hippocratic surgery” very little has
been done on the surgical writings, just as the gynecological treatises base
been utterly neglected. IVe welcome therefore the study of IV, Schleier-
macher, although the results are not particuharly exciting. The author
examines the composition of dyiiiov (On Fractures), and atfl SoScav
( n Joints). Both svere not originally independent writings, but parts of
one larger surgical book beginning with the ivordsTiiSt f; yEiootioyinvrat’
linosiov, while the treatise transmitted under the very inadequate title
xat Imoaov represents a mere abstract from the original book. The titles
mo avpiov and aejl a(,8oMv were given to the respective treatises by a late
200 and 150 n c.) who edited those sections of the orig-
‘lie order of the chapters but
g g the bepnnmg of at<il dynJiv and the end of mol

elnaHr "'■en W. H. Reseller, in several most fas-

e,rd^n P"*" tlEclared the treatise asol fp6o|td6tov to be the old-

Dosed at"the ii° 'k"^iv- P'’*’“°P''y- Roscher's ideas were violently op
Dubltcation ’’ others. Nosv, in a recent

has a man'' "'ho smells Pythagoreans everywhere and

nle hral r .Tc'’”® ononymous treatise to a well-known
folloiver of P ' F treatise to a Pythagorean physician of Cyrene. a
mann's arm. “ “'"*™t of the Cnidian school. Well-

of the raofTn convincing, and aecil fpSoiidStov is still one

appmaXed Cm " '"‘-"T ‘hat certainly has to be

approached from an entirety different angle

Sliidien Una SSi.zen Fur ^lur Hippoltraiischeii Aphonsmus." Hulortsche

1930. pp. 110, ‘-Auslemjner h-’, ** Festgabe Georg Sticker, Berlin,

Ncuburger gewidmet, Wien. 1928 Aphonsmuj." Festschnft

Aphorumus." Archw JUr CetchtchuderAtll’ ‘‘"tten hippokratidchen

Hippokratischcn Aphonsmen zu klaMiKh„ ntd*"

eruehrtft 80 189 191, 1933 ^ Bedcutung? AfuncAener medtzmuehe Woch-

32 Die Hippokrathche Schr,}] von ier ‘ f

T3rrei'’rxri;'’\"’^”r “ »

Fur OF„s,raiF a ttsl"""

ON HIPPOCRATES

109

.dUed by Puuger - are interesting docutnents oi the HjPP^ege^
The Codex Urbinas 68 H ^rbelieved to be part

ancient at aU bnt the

work o£ a humanist imitating the Hippocratic sty .

Another set o£ ^ Lntll^r”

Karl Deichgraber wrote a ve^^ by'^giving an excellent new

ceptions in the Hippocrauc oa ■ old document and then

German translation of this undoub dj^^ document following the in_
proceeds to analyre it. The P ^ contract between roaster and
vocation to the gods is “ 'j sacred lore of certain families

pupil. In ancient times medici ^ ,in,c went on. students from out-

Iransmitted only '^"''“‘^"“whaMhe first part of the oath, hovjever
side the family were * were, so to speak, adopted in o

teaches us is that these Sts and duties of

the family. They assumed all the r g historical condi

tvhile the first part of the oath i ,he physicia

tions, the second part P”'"'Si« are in accordance with the geneml

towards society. Some of these dutim a ^ physician who

ethical conceptions <>/ “"'^P^^^Icr^e his reputation (f ^1'"”,
faithfully complies with them nTofession. Some of these

“L theV^c’s confid^cem^^^^^^^^^^^ be physmian

however, according to P'“'Trese re^u-

than would be , ,bat trith one exception all ‘P® ^

Yet we must not overlook the act *at ^"1 t ‘ n"

lations are mere P™"" Joctor. but they ^

ought to do in order to abstain, svhat Sb-a to*'"**' ^

from which the physician should abs

Hlppoiwin a»»

hrieta ”

SCudiffn z

110

ON THE HISTORY OF MEDICINE

paragraph, I will keep pure and holy both my life and my art," is a
positive pledge

The oath certainly is a great document—its influence, if anything
proves that sufficiently Yet when we examine it critically, and we have
to do so as historians, we will find thrt utilitarian motives are far from
absent And, after all, what is the ultimate goal? What is the physician
seeking for who keeps his oath loyally? Reputation "Now if I carry out
this oath and break it not, may I gam for ever reputation among all men
for my life and for my art ’ The gam of reputation, however, is certainly
not the highest ideal we can conceive

Hippocrates, in the course of the centuries, became the father of raedi
cine, an ideal figure And yet he and Ins contemporaries were human,
very human, beings They had to make a living, they sold their services,
and the man who worked for money was not highly esteemed in Greek
society We think of the Hippocratic physicians as worthy bearded old
gentlemen uttering weighty wisdom, just as we cherish a sentimental pic
ture of the family doctor of old Bearded they were, the Hippocratics to
sure, but otherwise we must imagine them as acting very much as the
people do today who are living near the Orient And we know positively
that many of them were shrewd fellows

We are much indebted to Ludwig Edelstein for bringing our vieiis
nearer to reality Being a philologist and not a doctor, he was not bur
dened by 2500 years of professional tradition and could read the Hip-
pocratic tvritings much more objectively I mentioned his book before”
Having found that the treatise On Airs, Waters, Places had a prognostic
character, he naturally became interested in prognosis Why did Hippo
cratic medicine emphasize prognosis to such an extent? But before this
question could be answered another had to be raised what were the con
ditions of medical practice in Greece?

The Hippocratic physician was a craftsman, was educated as such
and as a rule, practiced his his craft, while wandering, like other
craftsmen— the shoemaker, the blacksmith, the artist Only larger com
munities had their permanent municipal physician whose salary ivas
raised through a special tax In smaller towns medical service was given
exclusively by the wandering physicians When such a doctor came he
knocked at the doors, offering his services like other craftsmen and
where he found sufficient work he rented a shop, the latreion, and set
tied down for a while The physician, as a rule, was unknown to his
patients There was no license guaranteeing a certain amount of knowl

ON HIPPOCRATES

111

edge. Everybody could call himself a physician and take care of patients
for money. For a doctor who came to a tmvn as a stranger, the best and
shortest way to acquire a reputation and to gain the confidence of the
people undoubtedly svas to make correct prognoses. This the patient and
his family could check. A physician who could tell right away what ivas
wrong svith a patient, and what would happen to him, could not but im-
press the people if his prognosis proved to be true. These peculiar con-
ditions of medical practice in ancient Greece svould explain, according
to Edelstein, the central position held by prognosis m Hippocratic

I think that there are other reasons besides this, svhich have to be
sought in the structure of Greek medicine, in

of disease. Nevertheless, Dr. Edelstein has advanced “

mendously, and we will have to reconcile ourselves “ f *
Hippocratic physicians were no demigods but just humble mortals, seek
ing the truth, erring, rejoicing, and suffering like oursc ves.

In antiquity it had already been noted “Tmitmnty'one

the Corpus Hippocraticum could not possi y |.„„cept. sometimes
man. They were found to be different m s y are^the "genuine

even antagonistic. The question, therefore, w ' j j ^ ,,.^5 said

works of Hippocrates,” and which the of writings,

before, it was relatively easy to ‘’'’'"“'.Vjj^jtises had originated in
There were definite indications as to sv nrobablHty had to be

the school of Cnidos. Those opposing them m p ,^^coonProg-

Coan. One treatise bore the mark of connected with this

notes. Hippocrates being a Coan natura y pT;„[,oCTates those Coan
group. It became customary to attribute he medical man.

treatises which seemed the best, winch appea ^^ ,vhile the minor \vritings

They were considered the "genuine wor ,

had to be the work of pupils. Anonymus Londtnen-

A real blorv was the discovery of t e so ^ pupil of Aristotle,

tit," a collection of medical abstiacB similar to those found in

Menon, who attributed views to H>pp ^

iTAnonymi Londinemis ex translation of it by

Aiistotelicum UI. 1. Berlin. 1893. There u * Unbekanntm a

and Franz Sp5t. “Anonymus Londm«»«. Au^ Aente. Berlin.

Menoas,” Handbuch der Medhtn und ao» »

112

ON THE HISTORY OF MEDICINE

nspl cpvocov (On Winds), a treatise that was generally considered as de-
cidedly pseudo Hippocratic

Ludwig Edelstem demonstrated very convincingly— and this is the last
chapter of his book*^— that we have no possibility ivhatever of attributing
any definite ivritmg to Hippocrates We know nothing about Hippoc
rates literary activity To connect him with any treatise is mere guess
ivork But then why was the Corpus called the Corpus Hippocraticum?
Why were all these treatises attributed even in antiquity to Hippocrates
and not to Herodikos or Euiyphon or any other doctor? What was the
process?

According to Dr Edelstem it was this to his contemporaries Hippoc
rates was not a particularly outstanding figure He was a famous physi
Clan and teacher of medicine— among many others Little was knovm
about his life and work otherwise the references ivould not be so scarce
The early Alexandrian physicians became interested in the history of
medicine In a very important testimony of that time (Scholion to Ihas
1 1, 515) It is said that dietetics were inaugurated by Herodikos and were
brought to perfection by Hippocrates Praxagoras and Chrysippus He
rophilus was a student of Praxagoras of Cos Erasistratus a student of
Chrysippus of Cnidos Hippocrates Praxagoras and Chrysippus were
mentioned together as the three leading men m the field of dietetics Hip"
pocrates however, ivas the senior of the three
The Alexandrian library contained many fifth and fourth century
medical books which must have been anonymous at the time they were
brought to Alexandria As soon as the interest m Hippocrates was
aroused the Alexandrian physicians and philologists endeavored to ascer
tain which of the anonymous books could be the work of Hippocrates In
this way a nucleus of Hippocratic ivritings was formed

As time went on the fame of Hippocrates increased To Celsus whose
work reproduces late Alexandrian knowledge he appears not as the man
who brought dietetics to perfection but as the oldest medical ■writer
{ vetustissimus auctor ) as the first of all worth being remembered
( primus ex omnibus memoria dignis I, 18 12 13) It is obvious that
more and more anonymous treatises were noiv ascribed to him

This process continued Hippocrates was more extensively heroized
To imperial Rome the fifth century b c was the Golden Age of Greece,

as We know the names of the first edtton see Max Wellmann “Hippokratesglossare ”
QuelUn vnd Studien xur Cese/iiehU dn halurwuseruchaften und der Mediun (Berhn)
2,1931

ON HIPPOCRATES

113

the time of the great classics, and Hippocrates svas one of them. Erotianus
considered him a witer ranking with Homer. He represented Galen’s
ideal of a ph)'sician.«® He noti^ tvas the father of medicine, and the entire
medical literature of the Golden Ages was naturally attributed to him,
although more critical minds had their doubts as to the genuineness of
some of the treatises.

Edelstein’s conception is a hypothesis, to be sure. There can be no
certainty when the material is so scant, but to me it is the most illuminat-
ing hypothesis on the subject ever professed, and I consider Edelstein’s
book the most important contribution to the Hippocratic problem since
the time of Littri.

Edelstein’s book naturally met with great opposition. What he had
said tvas so betvilderingly new, so much out of the traditional line, that
it required a considerable effort of thinking on the part of philologists
as well as medical men. I shall ahvays remember the evening in 1930
when Dr. Edelstein delivered a lecture on his investigations at the Leip-
zig Institute of the History of Medicine. He spoke for two hours, svith-
out manuscript, without a single note. The entire audience was en-
tranced. The youngest student felt that he had heard a very unusual
talk, and old philologists present at the meeting paid their tribute to
their young colleague. Later, however, after the publication of the book,
the attacks came. The reviews were uneasy and skeptical. The medical
reviewers saw an iconoclast in Edelstein. The philologists, fearing that
they ^vould have to revise their theories, expressed their disapproval in
general terms and attacked him on minor points.

Whoever wote on Hippocrates in Germany from 1931 on had to con-
sider Edelstein’s svork. The most important contribution from the other
camp was issued a fetv months ago, a large monograph of Karl Deich-
graber’s, on the Epidemics and the Corpus Hippocraticum. a preliminary
study to a history of the medical school of Cos.« It is very easy to review
Edelstein’s book, as it is svritten in a style as clear as crystal, but it is diffi-
cult to give an adequate picture of Deichgraber’s study in a few lines. It
is written in philological German and has to be read with the texts in

38 See Erast Wcnkcbacb, 'Der hippokiatischc Am als das Ideal Calens. Ncue Teatges-
taltung seiner Schrift "On h ficuno? loreJs xol ^4^60090;." Quellen und Sfudien iwr
Getehichte der Meditin und der Kalurwhsertsthaflt^ (Bexim) J(4):I55-I75. 1955 . See also
Hans Ciller. "Zur Hippokratesauffassung des Gate*." Hemes SSASJ-m. 1933 -
40 Kail Dcicheraber Die Epidemien und das Corpus HippotraUaim, Foruntersuchungeft
ra einer Geschichte der koisthen Aenteschufe. Abhandlangen der ^^schen Akademie
det IVissenscbaften. Jahigang 1953 , PhiL-Hlat. KlaM. ar. S. Berlin. 1955 , 172 pp.

ON THE HISTORY OF MEDICINE

114

*<= «™ «ud.es .s smking Edd«e.n.

cussedthewhoIesetofnrobr°"n'”’ From there htdii

and was also induced to to™ ufth
The results are very contract ™

centurier^ namel'^at ^ students o£ Hippocrates had done for

them to definite neriodrsHf' "f ‘S’'^ different imtings, attributing
result of the first Darf fu eventually to individuals The

always been recoffnized ac Epidemics I and III, which had

and that the Propnn^f,h 'vere ^mtten at about 410

dudes EptdemicsSl IV°L/v?f “ ^ “

zupcov (Humors), and the It'tween 399 and 395, mfl

OYMtuv aepi dnOomvI n^.i, treatises {xat’ ipreETov, pox^irdv, Kiel

to these groups are the svsSmT

(Nature of Man), then era, a *** ^f^^tise of Polybos ncpl ipvasws dvdeonov
rapl tegii; 'mcJ (Epitet.i ,u'^ Waters, Places) and

A third later, groun finali,, ' the work of one author

collection of notes rvritten^!,!* ^presented by Epidemics V and VII, a
^ptdemics the prognostic While in the other boob of

chiefly therapeutic fn puroos “ P'^'^'^t, books V and VII art
In the second part of h" ^

tions on Hippocrates and*L*« h then examines the tradi

With the writings Although h ^endeavoring to connect the men

to Hippocrates, he still strL^i definitely attribute any treatise

above is the work of Hid ” ^ ^ ‘eves that the first group mentioned

'"5 eTch^aVerTS^

niust confess that it ^ P'cce of thorough scholarship Yet I

arbitrary and farfetched m manv”^^ interpretation seems to me

are accepted as historical when T)ata m the biography of Soranu*

are rejected as legendary The ^ picture, othenvise they

nen5w IS a tour de/orctf of of the Anonymus Londt

has brought the approach to ih.. ®^hatism All m all, Deichgraber

ofLittr^ P*^® hack to where It was at the tune

Dr Edelstein, at the present time

for the Realenzyklopadte of Paul xJr *he article on Hippocrates

what he will have to sav to the 1 - ^ **^®wa, and we are anxious to sec

In the second cen Jry A

ppocrates was the generally recognized

ON HIPPOCRATES

115

^ authority on medicine. Galen concludes the century. He is an eclectic,
anxiously avoiding any aiHliation ivith a definite school. But there is one
^ master he serves— Hippocrates, He feels himself to be a Hippocratic
• physician, not a disciple but a worthy successor to Hippocrates. In a
monograph of high scholarship, Temkin*^ has pictured the very intricate
i history of Hippocratism from the time of Galen through the school of
Alexandria down to the time of the Arabian conquest. Hippocrates and
Galen are intimately connected in this development. The Hippocratism
that finds itself established in the fourth century, in Alexandria, due
largely to the work of Oribasius, is determined by Galen, This Hippoc-
ratism is medical as well as philosophical. The Alexandrian scholars are
iatrosophislae. A final chapter studies the canonization of the works of
Galen and Hippocrates and throws new light on endless detailed prob-
lems. ^Vorking on that period is like breaking the soil in a virgin forest.

Only a few Hippocratic treatises were translated into Latin in the early
Middle Ages until the wave of translations from the Arabic brought new
texts. In the later Middle Ages, some Hippocratic treatises, notably the
Aphorisms^ were much discussed and commented upon, but Galen and
Avicenna tvere the dominating authorities. The Renaissance witnessed a
revival of Hippocrates, and from then on the more the fame of Hippoc-
rates increased, so did the star of Galen decline. He appeared as the ideal
doctor. To be called the Hippocrates of one’s country was the highest
title of honor that could be bestowed upon a physician. Each period
looked at him differently and attributed to him all the qualities it was
missing in its otrn physicians.

Endless papers are being wilten in our day on Hippocrates and Hippo-
cratic medicine by medical men. They can be divided into three groups.

The first and by far the largest group consists of papers witten with-
out any knowledge of the sources, without any critical sense, mere com-
pilations from current textbooks perpetuating errors from generation to
generation. We need not mention them here. The sooner they are for-
gotten, the better.

Then there is a second group of studies in which medical men examine
the medical content of the Corpus Hippocraticum. It need not be em-
phasized that such studies are extraordinarily important. The philologist
« Otvsd Temkin, "Geschicbie des Hippokratismos im ausgehenden Altenum," Kyktos.
Jtthrbuch fur Geschichte und Philosophte dtrMedizm (Leipzig) ^:I-80, 1932.

116

ON THE HISTORY OF MEDICINE

will never be able to carry his investigations over a certain limit He will
always reach the point ivhere the medical man has to step in, ivith lus
knowledge of disease and medicine as a whole Ridiculous mistakes have
been made by philologists through ignorance of the medical facts Only
the physician will be able to decide what diseases were observed, how
correctly they were seen, what the underlying facts of a theory ivcre,
what a therapeutic procedure was worth

The medical man engaged m such studies, on the other hand, must
have some philological knowledge He must be able to read the original
text m the best available edition, must know all about the philological
work done before He must build upon it and continue it He will have
to avoid one mistake that is so often made, namely, to call progressive
what IS in accordance with our present day views and to discard as pnmi
tive what is different

A good example of a study belonging to this group is Georg Stickers
paper on fever and inflammation in the Hippocratic writings *■ Tcmkm's
Epilepsy, mentioned before,*^ has to be remembered here too This is
a particularly good example for a very happy combination of philological
and medical analysis Here is a wide field open to investigation A great
deal of work has still to be done on the diseases described in the Corpus
Hippocraticum, on the therapy of the Hippocratics A critical study on
Hippocratic dietetics would be extremely welcome

Two monographs have to be mentioned in this connection, although
they are not medical and although they deal only occasionally with
Hippocrates Both, however, are of great interest to the student of Hip
pocrates One is a study on the conception, ideals, and methods of science
among the ancient Greeks by 'William Arthur Heidel “ The chief criti
cism I have is that it does not sufficiently consider the work done on the
subject since 1914 The other book is similar in purpose a study on the
development of the research methods of ancient biology by G Senn **
Professor Senn is a biologist who has done a great deal of research on
Theophrastus and has devoted two very interesting papers to the experi

iSCcorg Sticker Fieber und Entzundung be« den Hippokratikern Archiv fur Ces
chtchte der Mednin 20 \50 170 1928 22 SIS 543 361 381 1929

43 William Arthur Heidel The Heroic Age of Science Carnegie Institution of Washing
ton Publication No 442 Baltimore 1933

44 G Senn Die Cntuicklung der biologischen Forschungsmeihode in der Anlike
thre grvndsatzUche Forderung durch Theophrast von Eresos VerdfFentlichungen der
Schwcuerischen Cescllschaft fiit Ceschlchte der Meduin und der Naiurwissenschaften VW
Aarau 1933

ON HIPPOCRATES

II7

ments described in the Hippocratic ivritings.^^ jjjj
development from the early beginnings among the sixth century philoso^
phers dmvn to Hellenistic times, stressing Theophrastus’ contributions
and giving full attention to the physicians.

The third group of medical papers on Hippocrates finally includes
studies on Hippocratic medicine as a svhole, discussing the general prin-
ciples— the “spirit” of Hippocratic medicine— which are svritten from a
purely medical point of vietv. Medicine today has become very efficient,
but at the same time highly technical and mechanized. It was not so in
the time of Hippocrates. Many ph)'stcians, dissatisfied with present day
conditions, feel themselves compelled to “go back to Hippocrates.” They
interpret the Hippocratic tvritings in their own way, valuing not the
technical knowledge but the general attitude of the Hippocratic physi-
cian towards nature and disease- 'TTiey tvrite on Hippocrates in order to
influence modem medicine.

Typical of this special line is the work of the great Berlin surgeon
August Bier. He s/rote a long series of articles on Hippocratism,** giving
a summary of his studies in a shorter paper, the beginning of which
characterizes the whole attitude splendidly; “The essence of Hippocra-
tism to which we have to revert under any circumstances, is the concept
of physis with the subordinate concepts oi constitution, right and wong
mixture of the body, attraction and reversion.”

The same attitude is shotvn in a book of the bacteriologist Hans Much,
whicli appeared under the title, Hippocrates the Great The book has
nothing whatever to do vrith Hippocrates. The name is merely a symbol,
a flag under which Dr. Much expressed his general ideas on medicine.

A similar study was svritten in Italy by Liborio Giuffr^,” and Arturo
Castiglioni gave a good analysis of the whole trend.®*^

<5 c. Senn. "Ueber Hwkunft und Stil der Bwebreibungen yon Expeiimenten im Corpus
Hippooaticum." Arehiv fur Geschiehie der Medmn, 22:217.289, 1929; "Nochraals die Ex-
perimente im Corpus Hippoaatiaim,” FerhandSungen der NaturfOTschenden Gesellschafl
(Basel) yj:109-l28. 1931. See also O. Regenbogen, "Eiae Forschungsmetbode aatilccr Natur-
wUsenschaft,” Que/ten und Studien zar G«cfiieAte der Matfiematik (Abt. B. Stadien)

2:131-182. Beilin, 1930. . ....

<6 August Bier. "Hippokraiismus,” Munchener Mediztnische n'ochensehnft 77:2193, 1950;
rS.-lIS, 15-1.555.408.483.540,919,961.1951. ^ v. j .

August Bier, -HippokraCiscfie StodJen.- Quellm und Sludten xur Ceschtchte der Sat-
urwissemchaften und der Medhin, (BerUn) t9^.

«8 Hans Much. Nippokrates der Crosse. SvallgnU Berlin. 1 926.

« Liborio Ciuffrfe. I.a d'Hif/>«>crate, Palermo, 19J5-M. ,r ,

5»Anu» Csitislioni, L'Oriat„<-Mo N-oIppocl.a, M
poraneo, Torino, 1933'XI.

118

ON THE HISTORY OF MEDICINE

This Neo Hippocratism is a distinctly romantic movement And it is
not b) accident that it is located chiefly in Germany and Italy, in those
UNO countries m which state and society are built upon the foundation
of an irrational mystical philosophy

Two medical journals today are published under the title Hippocrates,
one IS German, the other French They are very different in character
The German journal was launched m 1928®* I was one of the co-
editors of the first volumes so that 1 am pretty familiar with its history
The idea was to create an independent medical journal, an open forum
for medical discussions There was a great deal of unrest in postwar Ger
man medicine At the same time, powerful medical bodies and certain
big publishing firms endeavored to suppress certain trends Psychoanaly
sis was banned A homeopath could not have a paper printed outside his
own periodicals The new journal published with Hippocrates as patron
saint was to be open to every honest worker, regardless of his creed,
willing and able to contribute to the advancement of medicine
The new journal was started with great enthusiasm but soon proved
to be a failure Man) papers published were insignificant, others were
printed that were not vsortli tlie ink wasted on them, tlie really good and
valuable contributions would have had much more influence had they
been published in any of the weekly journals The editor, Georg Honig
mann, died m 1931 and the publication was interrupted until 1933 To-
day Hippocrates is a small, provincial, sectarian journal
The Frcncli Hippocrate began its career m March, 1933 It is called
a Revue rf Humanume Medical, and is edited by Dr Laignel Lavaistine
Professor of Medical History at the Pans Faculty It is not a scholarly
joumil and does not pretend lo be The idea is to keep the doctor in
touch vsith v\hat is going on m the various fields of arts and sciences The
articles published deal with medical history, general history, history of
art and literature They arc nev cr profound but usually interesting E^ch
number pubhslies clironiqiics' surveys of the diflcrcni fields and book
reviews The reader in this vsay hears v\hal is being done in philosophy,
psychology, biology, poetry, music, etc

81 Zfiiiehnft /flr EtnhtiUb€itTebungtn dcr Cegenvortsmeditin The present
title It l/tppolfefer Zeitsrhnlt JQr pTaktis€f e Medijn Organ /Qr Etnheitsbrstrtbungfn
der MfdiJn llippuVrater Verbg Stuilgatt Lciprig
83 //(ppoeraif, /{n-we «f //urrMfinme Sf/dteet, i aiti 15 Rue ciu Sotnmerard.

ON HIPPOCRATES

119

Is this medical humanism? Probably not. But the journal is well done,
original in purpose, and it certainly fulblls a not unimportant function.

It is a great thing that the medical profession has in Hippocrates a living
ideal, a hero that it can worship and foUoAv. However, this should not
prevent the historian from seeking the truth. Investigating the sources
critically, he will have to destroy illusions occasionally. The ideal will
remain untouched.

The purpose of this very fragmentary review ivas to give a brief picture
of the wious activities In the field of Hippocratic research. Important
tvork is being done, work that should be taken into careful consideration
by all medical men ^vho talk and svrite on Hippocrates.

MEDIEVAL MEDICINE

can approach the medical history o£ a period from different
points of vieiv, from that of practical achievements or from that of ideas
Medicine is a craft and a science As a craft it is frequently transmitted
by word of mouth and practical instruction from father to son and from
master to pupil As a science medicine is one aspect of the general culture
of a period It reflects man s attitude toward nature, toward the phe
nomena of life and death It is expressed in literary form, and the medi
cal books represent one aspect of the literature of a period sharing its
general style We may be more interested in the health conditions and
healtli hazards of a period and m the treatments and diets applied to cure
disease or to prevent it Or we may be more attracted by the ideas that
guided the physicians actions In the following brief sketch of medieval
medicine I shall not be able to discuss its practical attainments in a more
than cursory way Rather I will try to determine the place of medieval
medicine in the history of civilization

Our symposium has a serious gap in that it jumps from ancient Egyp-
tian to medieval medicine and has omitted a discussion of Greek medi
cine And yet it was Greek experience and Greek thought that constituted
the basic content of medioal medicine Greek medicine was transmitted
to the medieval isorld and i\as gradually assimilated by it A synthesis of
rare liarmony was achieved between Greek and medieval views until, m
the Renaissance, the western world re\olted against traditions Let us
examine this process

MEDIEVAL MEDICINE

121

We must remember that medieval medicine had tsvo centeia o£ develop,
ment. the Muslim empire in the East and the Christian world in the
West.*

In the seventh century a.d.. Arab tribes, driven from their homeland
by the aridity of the soil, united and disciplined by a new creed, moved
north seeking more fertile lands. They conquered Syria, turned west,
conquered Egypt, the whole coast of North Africa, went over to Spain,
crossed the P)Tcnecs, until they were stopped in France. In less than a
century they had founded an empire that reached from the Pyrenees to
the Indus River. They tvere tolerant. No one was forced to embrace the
new religion, but the infidel svas a subject heavily taxed. It was highly
profitable to become a Mohammedan. The convert acquired Arabic
citizenship and became a member of the ruling class. Millions adopted
a religion tvliich, after all, tvas not so different from Christianity. The
new empire was united by a common faith, disciplined by religious rites,
and, since the Koran was not to be translated, it had a common language.

The Arabic conquerors were a rough crowd, horsemen, tvarriors, poets
at times, but little experienced in the arts and crafts. They soon found
that the people they had subjugated had better architects, painters, en-
gineers, and physicians. They hired them and soon began learning from
them. Alexandria, although the famous library had been destroyed before
the conquest, was still a center of learning. It was obscured by mystic
currents but svas backed by a great tradition; Paulus of Aegina, the last
great Greek medical compilator, Ih'cd there in the first half of the seventh
century.

More important because it svas infinitely more dynamic svas another
intellectual center, Gondeshapur. in Persia. A foundation of Sassanian
kings, it had become an asylum for refugee scholars. Greek philosophers
driven from Athens by Justinian, Christian heretics, Ncstorians driven
from Nisibis convened in Gondeshapur where they came in touch with
Penian and Indian thought. Of all the sciences medicine svas probably
the most flourishing, centered around a hospital and an academy. Synac
had become the language of learning in ‘Western Asia, and many classics
of Greek philosophy, science, and medicine were translated into Syriac.

And so the Arabs found in the territory of their conquest not only
ilf I speaV of East and Wot, I do it for the ale of brevity. I am well aware that
throughout the hfiddle Age* there were Mohammedani in Spain and OiriiUan* in Syria.

m ON THE HISTORY OF MEDICINE

intellectual centers but they found in addition the chief Greek medical
literature already translated into a Semitic language Books were the
source of knowledge, and the delivery of books, particularly of alchemical
and medical books, was more than once made a condition of peace
treaties with the Byzantine empire Once a book was available in Syriac
version, it was an easy matter to have it translated into Arabic After
this was done, the book could be read and used by all who needed it from
the Pyrenees to India

In the second half of the eighth and throughout the ninth century an
endless number of Greek books were translated m this way the works
of Galen and his successors, but also Hippocratic writings and the Ma
terta Medica of Dioscondes, the latter gorgeously illustrated and a book
that IS still consulted m the Orient today The chief ' transmitter’ was
Hunayn ibn Ishaq, who was head of a regular school of translators in
Baghdad at the court of the Abbasid caliphs He was assisted by his son
Ishaq and his nephew Hubaysh, and tradition attributes to him over
ninety pupils Most of these translators were Christian scholars They
were the linguists of the day, mastering Greek, Syriac, Arabic, and often
Persian They usually first translated a book into Syriac for the use of
their fellow Christians, then into Arabic for the use of Muslims Just as
the Ptolemies in the third century b c had sent out regular expeditions
in search of Greek manuscripts for the Alexandrian library, so did the
Abbasid caliphs for the library in Baghdad

At the end of the ninth century the Arabic speaking world was m full
possession of the Greek medical tradition It ivas a medical science that
had lost its momentum and had completed its coune It was, moreover,
the science of another people, different m race and outlook Nevertheless,
It was the accumulated experience of centuries of observation and reason
mg, innumerable facts about diseases and their treatment, that became
available to the Islamic world in this way

Developments were similar and yet different in the West There too it
ivas hunger that drove barbaric tribes into the fertile fields of the Roman
Empire and started a migration of nations The Germanic people that
settled m the western part of the Roman Empire had just as pnmitive
medical knowledge as the Bedouins of Arabia They too all of a sudden
came m touch with a much higher civilization In the East the Arabs
went on their conquest with a new religion that ivas gradually adopted
by the subjugated nations With their religion they took over the con
queror’s language, at least as a literary language In the West the process

MEDIEVAL MEDICINE

123

was different. The Goths ivere converted to Christianity, which ivas the
official religion of the Roman Empire, Its language ^vas I^tin, and Latin
became for centuries the literary language of all nations that recognized
the authority of the Church of Rome.

For over 1000 years medical books had been svritten in Greek through*
out the Graeco-Roman svorld, and very fesv Latin medical books svere
assailable. But Latin was becoming an iricreasingly important language.
It was the language of the court, the administration, and the church. It
was the vernacular language of Italy, Gaul, and Spain, and was the liter-
ary language not only in Germany but in North Africa and Britain.
There was a strong demand for medical books tmtten in Latin. Trans-
lations were made in the West as in the East, and from the fourth century
on a new medical literature developed which was svritten directly in
Latin. It was not original in character but consisted of compilations, its
value depending on the sources used. The West had intellectual centers
also. One such center was North Africa, in the fourth and 6fth centuries,
where Saint Augustine lived and where one of his friends, the physician
Vindidan, and his pupil Theodorus Priscianus compiled some important
books. An African, Caelius Aurelianus, translated Soranus and thus pre*
served the experience of the Methodist school, the doctrine of which was
very influential in the early Middle Ages.

Another such center was Bordeaux, famous for its school of rhetoric.
But there were physicians there too, such as Marcellus Burdigalensis,
who compiled a very popular collection of prescriptions, Ravenna, the
residence of Theodoric, had in the sixth century a medical school the
outlines of Avhich %ve just begin to perceive. It had iatrosopkistae, pro-
fessors of medicine, who interpreted the Galenic canon in Latin in the
same way as was done in Alexandria in Greek. Oribasius was translated
twice in Ravenna, and there can be no doubt as to the importance of this
school. Roman inscicurions did not perish in the early Middle Ages. Many
schools flourished in Italy in the Lombard period and became starting
points of universities, as was the case in Bologna.

At the time when Harun al-Rashid attracted scholars and artists to his
court. Charlemagne did the same in the West and laid the foundation for
schools that were to become famous in Tours, Chartres, Rheims. At the
same time, Benedictine abbeys, like Monte Cassino, Bobbio, St. Gail,
copied, and passed on from generation to generation.

Fulda, were centers of learning where ancient literature tvas studied,

There can be no doubt, however, that the Muslim world was far ahead

124

ON THE HISTORY OF MEDICINE

of the western world m the early Middle Ages Around 900 the Arabs
were in full possession of the Greek medical tradition In the West some
works of Hippocrates and Galen, the materia medico of Dioscondes,
Soranus, and some other great writers were translated as early as the
sixth century, but around 900 they were almost forgotten The popular
literature consisted of short treatises compiled for practical purposes in
Greek in the fourth century mostly, translated into Latin in the sixth
century They were translated into Syriac, Arabic, and Hebrew also, but
were superseded by better literature In the West, however, these short
treatises dealing with urine, pulse, fever, diets, prognostic, bloodletting
and pharmacology constituted the bulk of ancient literature that i\as
still alive in Carolingian days

Dioscondes the chief source of ancient materia medtca, was translated
three times in the early Middle Ages, but of one version we have only an
indirect testimony A second version is preserved only in short fragments,
and of the third only two manuscripts have survived, while we still have
over fifty manuscripts of the herbal of Pseudo Apuleius This shows how
infinitely more popular this very inferior treatise was The prognostic of
Hippocrates was translated twice, but both versions arc known only in
short fragments, while there are many manuscripts of the so-called Prog
nostiea Democrtii

In 732 the Arabs were repulsed from France, but they remained m
Spam until 1492 They conquered Sicily in 827 and ruled the island until
the end of the eleventh century From the eleventh to the thirteenth cen
tury East and West clashed m the crusades Intercourse between the tivo
civilizations became very close Different as they were, they had a great
deal in common due to their common heritage Not only commercial
but also intellectual relations increased, and, since the Arabs were more
advanced m science and medicine, Europe began to learn from them

In the eleventh century, Constantine, an African by birth and there
tore a master m eastern languages, traveled all over the Orient and came
to Monte Cassino where he became a monk, bringing with him Arabic
medical books that he translated into Latin He thus greatly enriched
western literature and made Greek and Arabic writers available that had
not been known before

Toledo, one of the chief centers and the western outpost of Arabic
learning, v\-a5 conquered by Alfonso VI of Castile in 1085, but it mam
tamed its position under Christian rule It thus became the center from
which eastern knowledge was transmitted to tlic "West In Toledo m the

MEDIEVAL MEDICINE

125

hvdfth century Gerard o£ Cremona and his students translated a large
number of Greek and Arabic medical, scientific, and philosophic miters
from Arabic into Latin. In the early thirteenth century the irestem world
possessed the Greek medical tradition as the Arabs had done three
hundred years before, and possessed in addition the experience of many
Arabic scholan.

The Greek medicine that was transmitted to the Middle Ages, in the
East and in the West, was the result of a development of over 1000 years.
All schools of thought from the early pre-Socratic philosophers to Plato,
Aristotle, the Stoics, Epicureans, and Skeptics, to the vagaries of Neo-
Platonists and Neo-Pythagoreans, were reflected in some way or other in
the physicians’ theories. This enormous mass of literature was transmitted
in a relatively short period of time, in a haphazard way without any order.
A book ivas translated tvhen good manuscripts ivere available. This de-
termined the choice first of all. Hunayn ibn Ishaq translated one day the
Hippocratic Aphorisms, a book written around 400 b.c., and some other
day he made a version of a Galenic treatise tvritten almost 600 years later.
Gerard of Cremona within a few years rendered such disparate books in
Latin as the Techne iatrike of Galen and the Liber Almansorius of
Rhazes. This new literature svas taken over not as a collection of histori-
cal documents but as a living whole. It was studied not by medical his-
torians but by physicians desirous of learning from it ho^v to treat their
patients and how to comprehend the phenomena of health and disease.
Viewed from such an angle, the Greek medical tradition Avas extremely
bewildering. It svas full of contradictions. Many descriptions of diseases
and many prescriptions sverc unintelligible. A theory that a Greek physi-
cian familiar with the philosophy of Pythagoras found easy to understand
seemed strange and foreign to an Arab or Christian cleric of the early
days. A great deal of interpretation tvas required before this nesv learning
could be assimilated.

Dictionaries were written for the elucidation of difficult terms or con-
cepts, commentaries to explain authoritative texts, concordances in
Avhich similar opinions were brought together, conciliators to reconcile
divergent views. Such books were svritten in the East and in the ^Vest.

The Greek tradition, hoivcver, carried to the Middle Ages not only
doctrines but basic observations and methods. It taught that disease is a

126

ON THE HISTORY OF MEDICINE

natural process not essentially different from physiological processes It
taught further that the human body has a natural healing power which
tends to overcome lesions and to restore the lost balance of health, that
all actions of the physician must therefore be directed toward aiding this
vts medtcatnx naturae The Greek tradition taken as a whole, regardless
of doctrines, taught how to approach a sick man, what questions he
should be asked, how to examine him, and how his symptoms must be
evaluated so as to know what fate has in store for him Greek medical
literature of all periods was full of unsurpassed descriptions of disease

, ^ and disease pictures And It contained a wealth of information

concerning the treatment of diseases— dietetic, pharmacological, physical,
and surgical— the result of centuries of experience Once this knowledge
was assimilated medicine could advance And it did, in the East and in
the West

The tenth and eleventh centuries were the golden age of Arabic medi
cine The leading physicians were no longer Christians but Muslims
They came from all parts of the empire, many of them from Persia Hos
pitals were built m inaeasing numbers from the ninth century on They
were not poorhouses or almshouses like the western hospitals of that
period They were places where sick people were treated, where physi
cians gathered experience and instructed students

The number of Arabic writing physicians iv’ho enriched medical
knowledge is large Many of their rvritings are lost or still buned m
manuscripts Let me mention only a few names and a few contributions
AI Razi (Rhazes), probably the greatest Muslim clinician, was an ex
tremely versatile scholar, physician, scientist philosopher, and theolo-
gian We admire him not so much for his Conlinens, an encyclopedic
textbook of medicine, as for his case histones, monographs, and short
treatises m which he established new disease entities Most famous is his
book On Smallpox and Measles, remarkable also lus treatise On Slone tn
Bladder and Kidneys Many more are still unpublished Rhazes' medical
doctrine was Greek, to be sure, but by applying Greek methods of clinical
observation and research lie enriched medicine considerably

Another distinguished clinician of the period was All ibn el Abbas
(Haly Abbas), like Rhazes a Persian He too wrote a comprehensive text
book of medicine which is full of valuable observations and reflections
He took a critical attitude toward his predecessors, Greek and Arabic,
and accepted from them vs hat he considered true

All sections of the empire contributed to the golden age of Arabic

MEDIEVAL MEDICINE

127

medicine. An Egyptian Jew. Isaac, wrote important monographs on
fever, urine, diets, and drugs. One of fiis students, Ibn al-Jazzar, became
well knotvn for a little book in which he gave dietetic advice to travelers.
It was translated not only into Latin but also into Greek and Hebrew.
The greatest surgeon of the period, Afau'l Kasim, was bom in Spain in
El-Zahra near Cordova. He was influenced by Greek tvriters, notably
Paulus of Aegina, but rvas an experienced surgeon himself. Materia
medica -was greatly enriched by Arabic writers. An empire that covered
such a vast territory yielded drugs from all climates. A mere list of Mus-
lim physicians who contributed to the subject would fill many pages and
include names from all provinces.

The Greek tradition was assimilated in the 'West also, but later than
in the East and in a somewhat different way. As we mentioned before, it
was transmitted not in its pure form but after having gone through the
Arabic channel. The experience of the Greeks was made available to
the western Middle Ages together tvith that of the Arabs, Constantinus
Africanus in the eleventh century translated not only works of Hippoc-
rates and Galen bat also chose of Rhazes, Isaac Judaeus, Ibn al-Jazzar, and
other Arabic ■writers.

Constantinus’ work marks a turning point in western medieval medi-
cine. It became known in southern Italy just at the time when the school
of Salerno tras developing vigorously. Salerno tvas a trading totvn ■where
Greek was heard in the streets and where western and eastern influences
converged. A group of physicians, laymen and clerics, were practicing in
the town, sought by patients and by students from all over Europe. In
response to a strong demand for a richer medical literature they compiled
books such as the Passionarius Galeni which, however, still had all the
characteristics of the early medieval literature. The translations of Con-
stantine acted a-s a strong stimulus. They found in Salerno a group of
physicians that was ready to absorb and assimilate them. The literature
that Salerno produced in the twelfth century started a nesr movement in
western medicine. The many books they rvrote on all subjects of practical
and theoretical medicine reveal that the Salernitan masters had not only
assimilated the Graeco-Arabic tradition but had already been able to add
observations of their otvn. It is highly significant that they were fully
aware of the importance of anatomical studies. Human bodies were not
yet dissected, but those of animals tvere.

Another important contribution to medicine, though of a different
order, came from southern Italy. Frederick 11 in his ConstiCutiones of

128

ON THE HISTORY OF MEDICINE

1240 set definite standards for the practice of medicine by requiring a
prescribed curriculum of nine years, examination by the Salernitan
masters in the presence of a representative of the state, and by licensing
the medical profession This gave it a status it had not had before

When Gerard of Cremona and his group were at work in Toledo, an
other medical school had come into existence not far from Spam, in
Montpellier Just as Salerno had profited by the first wave of translations
Montpellier did by the second The interpretation and assimilation of
this new literature became one of the chief tasks of the young western

If we wish to watch the medieval physician at work, we must not only
consult the textbooks Textbooks, even in our days, always have to a cer
tarn extent the character of compilations since no man's original re
searches can cover an entire field We must read the Constlta, missives
m which a doctor discussed a definite case Or we must watch him fight
mg epidemics When the black death ravaged Europe in 1S48 the physi
cians had to face a problem for which ancient medicine did not give any
solution Or we must look at the surgeon operating on a soldier after a
battle

When we do this we soon find that Western medicine too had ab
sorbed the Greek tradition and rvas enriching it by many important
observations

So far we have spoken of the transmission of Greek medicine and its
assimilation and enrichment by medieval physicians Was this all? Was
medieval medicine nothing else but a reminiscence of ancient Greece a
belated outgrowth of Hellenistic medicine? Is it possible for a civihza
tion that IS alive to take over ideas and systems which are deeply rooted
m another civilization without modifying them? The Middle Ages m the
East and West, produced new forms of expression m the social and eco
nomic life in government, law, theology art, and literature Is it con
ceivable that they could have left medicine without their imprint? In
other words is there such a thing as an essentially medieval medicine?

Of course there is A synthesis was accomplished in this field also So
far, little research has been done on the subject and all I can do is to
show where this synthesis is to be found

A work like the Canon of Avicenna could not have been written m

MEDIEVAL MEDICINE

129

antiquity. Avicenna, one of the greatest physicians and philosophers of
Islam, attempted to build a complete, logical, and well-rounded system of
medicine. Its elements are to a large extent Greek-Greek medical ex-
perience and thought, Aristotelian philosophy, with a tinge of Neo-
Platonism. To this was added the experience of several centuries of
Arabic medicine and a great deal of personal experience. With these
elements in hand, Avicenna created a system that svas no longer Greek
but tvas an expression of Muslim philosophy. It tvas so forceful and
persuasive tliat it dominated medicine in the East and the West for 600
years.

In another sphere of medieval culture we find a physician-philosopher,
Maimonides, who wote Aphorisms According to Galen. The book is by
no means a mere repetition of Galenic doctrines. Maimonides selected
passages from Galen. He selected what appealed to him particularly, and
the dioice he made already reflected bis personality. He took a state-
ment from Galen as motif and developed it in his o^vn way, thus creating
a synthesis of Greek, Arabic, and Jewish thought.

The same synthetic process can be traced in the works of the western
scholastic physicians of the thirteenth and fourteenth centuries, Albenus
Magnus, Roger Bacon, Amald of Villanova, Pietro d'Abano, to mention
only a few. Aristotle, Galen, and Avicenna were their masters. They
quote them constantly and follow their methods. Cm they did more.
They were Christian scholars. Theology was the mother of science and
learning, and they succeeded in creating systems in which the experience
of medicine became part of the Catholic concept of the world. Their
^vorks are essentially medieval.

The parallelism m the developtnent of medicine in the East and in the
West is striking but is easily explained by the common heritage and by
the whole situation in which both groups of people found themselves in
the early Middle Ages, It is much more difficult to explain why this
parallelism came to an end.

The golden age of Arabic medicine svas shorL After 1100 there was a
steady decline. Factual contribuuons to medicine were still made and
many books were svritten. but there svas hardly any development. People
looked backward and not into the future, commented upon their classia
and followed traditional patterns of thought. The Islamic world re-

ISO

ON THE HISTORY OF MEDICINE

mamed medieval to our days except in the few sections that have re
cently adopted features of nestem civilization

Matters were different m the West, and the Renaissance marked the
turning point It is a matter of speculation to determine what forces
created that great and deep movement I shall not attempt to discuss the
problem in this brief paper There was a primitive accumulation of capi
tal m the East just as much as m the West, perhaps even more, but it was
Europe that developed a capitalist economy Great voyages of discovery
undertaken by the Arabs long before Europe was thinking of a sea
to India but the European voyages had a much more profound
influence They affected Western economy deeply and became a stirring
experience

One of the essential traits of the Renaissance was its attitude of revolt
against the traditional authorities The most powerful medieval author
ity, the church, was attacked and ‘ reformed ' The power of the crafts
men s guilds was broken by the developing industry The authority of the
medical faculties was opposed and their power to regulate the practice
of medicine was gradually taken over by other agencies
Throughout the Middle Ages the Greek medical tradition was ac
ccpted as authoritative It was open to interpretation, to be sure, but its
authority was hardly ever questioned Now physicians v«-ote books De
Phnti et Aliorum Medicorum Errortbus This revolt against tradition
was sometimes dramatic, as in the case of Paracelsus It was usually less
spectacular but was a revolt nevertheless, and it paved the way to a new
medical science

BEDSIDE MANNERS
IN THE MIDDLE AGES:
THE TREATISE DE CAUTELIS
MEDICORUM ATTRIBUTED
TO ARNALD OF VILLANOVA

INCE I published a study on the book De Vinis^ of the great scho-
lastic Spanish physician Amald of Villanova {1235?-13n),2 1 have been
examining some of his other treatises, among which is one of a few pages
only, entitled Arnaldi de ViUaNovade Caulelis Medicorum? which fora
long time has been the subject of controversies. The treatise, similar in
title and intention to that of the fourteenth century Bolognese physician
Albertus de Zancariis,^ discusses the physician’s conduct in the course of
his practice and advises him to take certain precautions in dealing with
patients of various classes and their relatives, and particularly also in the
practice of uroscopy.

We learn that patients sometimes deceived their doctors when they
sent them their urine for examination, probably in order to test their
knowledge and skill. It is only fair that doctors should have been warned

1 The Earlint Printed Book on Wine, by Amald Vllanova .... New York, Henry
Schuman, 1943.

2 For the biography see Menendci Pcfayo*. ffistorio de los tfeterodoxos Espariotes,

Madrid, 1880; Barth^letny Haurdau, "Amauld de Villeneuve," In fiistoire LittiToire de la
Trance, vol. 28. Paris, 1881, pp. 26-126; Paul Diepgen, Amald von Villanova als Politiher
und Laimlheologe. Berlin-Leipzig, 1909; Paul Diej^en, "Siudlen ru Amald von Villanova,"
Archiv fur Ceschichte der MedMn 188.198, 569-596. 1910; 5:88-120, 1912; d:580-

400, 1913; Paul Diepgen, “Die Weltanschauung Amaldj von Villanova und seine Medizin,"
Seientia 6/:88-47. 1937. The thesis of E. Lafaode. Amauld de Villeneuve, sa Vie el tet
Oeuvres. Paris. 1896, is quite uncritical and lull of erron.

» In the iMlition Basilcae 1585. which I am using, the text is found on col. 1433-1458.

* Manuel Morris. Die Schrift des Albertus de Zoncariis aas Bologna, De Cautelis Medi-
corum httbendis. Dissertation, Leipzig, 1914.

132

ON THE HISTORY OF MEDICINE

against such trickery, and it may be pardonable that they were instructed
how to fight back even if such behavior may not seem very ethical Pa
tients then as today expected their doctors to be omniscient and— at that
time— some physicians thought that they had to live up to these expecta
tions and pretend to know more than they actually did
Kurt Sprengel in his Versuch etner pragmaltschen Geschichte der
Arzneykunde attacked Amald violently “ Speaking of this treatise he said
Particularly interesting are his instructions concerning uroscopy which
are so obviously the work of a crook that ^snth Petrarca ^ve can only be
wail the destiny of the times when for centuries the noblest art was in
the hands of such unworthy clowns

Haur^au in the HistQire Litlcraxre de la France^ accepted Amald s
authorship without morali 2 ing comments and Lalande even warmly de
fended Amald s views white as early as 1847 A W E Th Henschel the
learned editor of the old Janxis^ expressed highest indignation at the
idea that such a quack treatise should have been attributed to so great a
man and he solemnly protested against any conclusion that Sprengel had
dravm against Amald from this miserable smear tract *

Yet the problem is not a moral but a literary one Medieval physicians
and surgeons held views that were in many ways different from ours and
Paul Diepgen to whom we owe the most profound studies on Arnald
made it quite clear that he was very ambitious a publicity seeker a
politician in the evil sense of the word that he had not a straight for
^vard nature and that he was not meticulous in the choice of the means
he used A he meant nothing to him Extreme exaggerations were fre
quent with him but he was not always conscious of his insincenty * This
is not a flattering picture and from a moral point of view there is no
reason why Arnald should not at some time or other^® have jotted dotvn
the precepts of this little treatise

A literary analysis however reveals immediately that the treatise can
not have been written by one man The style and whole tenor change

s Part II ed 3 Halle 1823 p 624
eVol 28 pp 68 69 Pans 1881

7 Janus Zeilschrilt fUr Ctseh ehte und Ltteratur der Mtdttfn Volume 1 was published
in 1846

s aus d esem iammerl chen Sudclvrerlix /aniu2S48 1B47
9 Archiv fUr Gesehtchte der Med sin J \\6 1911

10 Amald was a great traveler and aometmes used forced le sure for the composition o
BOtne treatise Thus between 1309 and ISIl he wrote his treatise De VmU when a nor
wind had driven hu ship to North Africa where he was stranded for some tune

BEDSIDE MANNERS IN THE MIDDLE AGES

133

several times, and there are open contradictions bettv-een beginning and
end.*‘ Hcnsdiel already recognized that the treatise consists of several
different parts. He distinguished four:

I. The initial section on uroscopy beginning Videndae sunt cautetae
circa urinas (col. 1453 in the edition of 1585) and ending el caveas tibi
quoniam magniis honor est Afedico, si sciat sibi cavere, quia mulloties
inlerrogaiur (1455 B).

H. A short paragraph of 10 lines, Nola quod medicus debet esse in
cognoscendo studiosus . , . bertevolus patienti debet esse (1455 B-C).

III. The largest section, Aiedteus cum ad oegrotum vocaberis (1455 C)
to gum ilia cogunt ciftarta indigesta exire, vel digestionem retardant
(1458 B), which as Hcnschel correctly recognized is nothing else than the
first third of a text that also occurs in the twelfth century Codex Salemi-
tanus of Breslau** and that was published by de Renzi in his CoUectio
SalemitanaP Henschel did not know at that lime that his text is itself
an abstract of a large treatise De Instructione Medici of the Salernitan
physician Archimatthacus.**

IV. A few terminal sentences, Nota proeierea, quod medicum in prin-
cipio morbi . . . sicut dtxi in alio capitulo, qui incitabalur. O medice, Deo
gratifls. (1458 C-D).

Thus we sec chat the bulk of the treatise (part III) was not witten by
Arnald but was knoivn a century before his time. Can any other part be
attributed to him? Henschel, endeavoring to glorify his hero, thought
that only pan II might be his work, which seems unlikely to me. Part II
consists of only one paragraph which, although not identical, yet is very
similar in character to the early medieval deontological texts published
by Ernst Hirsclifeld.*®

Pan IV is not an independent section but belongs to part III. It con-
sists merely of a few sentences that belong to the same text as it might
have occurred in another than the Breslau manuscript.

ilThuj a passage in part II forbids the phpidan to promise the patient health, while
another fn part III sass that it should he done.

12 See Hcnschel. "Die SaleinitanUcfae Handschrift." /anus i:S07-309. 1845. Karl Sudhoff.
"Die SalenjJianer Handschrift in BresUu (Ein Corpus Medicinae Salemi)/' fur

Geschichte dtr Medizin 12:114, 1920.

13 Volume II. p. 72 If., Naples, 1855.

lilt was published by de Renzi in »ol. V. pp- SSS-M9. Napla, 1859. About the author,
see Hans Ei^cnbrecher. Der Salemitaner Arzt ArtMmatthasus Duseruuon, X-cipug.

liArchivJur Geschichte der Ueditin 20:553-571. 1928.

134

ON THE HISTORY OT MEDICINE

Pan I IS the one that has shocked physicians most Was this Arnald s
work? It is not impossible, although I cannot give any definite answer to
the question at the moment The Opera include a number of other short
—and very interesting— treatises that liave shocked tender souls, although
they must have delighted medie\al readers Such were De Decoratione
and De Ornatu Multerum, two revealing treatises on cosmetics, or De
Maleficiis that teaches how to restore the virility of a man who has been
bewitched All these treatises must be examined together some day, and
their views and style must be compared with those of the undoubtedly
genuine works

There is another point which in such cases must always be kept in
mind When a scholar dies— and this applies to the Middle Ages as well
as to our own days— the students who examine the papers of his desk will
find a lot of notes, abstracts, drafts, raw materials that were never in
tended or were not ready for publication It is quite conceivable that
Arnald planned a treatise De Caulelts Medicorum, that he copied pas
sages on the subject from earlier manuscripts, added perhaps a few notes
of his own, and that this unfinished product was later circulated under
his name

Whoever the author or authors may have been, there is no doubt that
the treatise is medieval and that it is interesting m that it gives us a pic
ture of what the behavior and bedside manners of certain doctors were
at that time Since it went under the great name of Arnald, it must have
exerted a certain influence

The Latin original is readily accessible as it is included m all editions
of Arnald s Opera from 1504 on In the following I have attempted to
give an English translation that was not always easy because the text is
written in a rather vulgar Latin and is corrupt in several places

ON THE PRECAUTIONS THAT PHYSICIANS MUST OBSERVE

We must consider the precautions with regard to urines by which we can protect
ourselves against people who wish to deceive us The very fint shall consist in finding
out whether the urine be of man or of another animal or another fluid and if it i*
human urine it is diagnosed in four ways

The second precaution is with regard to the individual who brings the urine
You must look at him sharply and keep your eyes straight on him or on his face and
if he wishes to deceive you he will start laughing or the color of his face will change
and then you must curse him forever and in all eternity

135

BEDSIDE MANNERS IN THE MIDDLE AGES

The third precaution 5s also with regard to the individual who brings the urine,
whether man or woman, for you must see whether he or she is pale, and after you
have ascertained that this is the individual’s urine, say to him; "Verily, this urine
resembles you," and talk about the pallor, because immediately you will hear all
about his illness. It commonly happens with poor people and those of moderate
means that the)' go to the doctor when they are afflicted very seriously.

The fourth precaution Is with regard to sex. An old woman wants to have your
opinion. You inquire whose urine it is, and the old woman will say to you; "Don't
you know it?” Then look at her in a certain way from the corner of your eye, and
ask: "IVhat relation « it of yours?” And if she is not too crootcd, she will say that
the patient is a male or female relation, or something from which you can distin-
guish the sex. Should she say: “IVe are not related,” then ask what the patient used
to do when he was in good health, and from the patient’s doing you can recognize
or deduce the sex.

The fifth precaution is that you must ask if the patient is old. If the messenger
says yes. you must say that he greatly suffers from the stomach, and chat he spits a
lot, and in the morning more than at any other time, for old people have by nature
a cold stomach.

The sixth precaution; whether this illness has lasted for a long time or not. If the
messenger says that It has. you must say that the patient is altogether irritable and
that one on help him. or some such talk. If he says no. you must say that the
patient is altogether oppressed because in the beginnings ol diseases there is much
matter that oppresses the organ.

There is a seventh precaution, and it is a very general one; you may not find out
anything about the case, then say that he has an obstruction in the liver. He may
say; "No, sir, on the contrary he has pains in the head, or in the legs or in other
organs." You must say that this comes from the liver or from the stomach; and
particularly use the svord, obstruction, because they do not undentand what it
means, and it helps greatly that a term is not understood by the people.

The eighth precaution is with regard to conception. An old svoman consults
you because the patient cannot become pr^ant. Perhaps you do not know the came
but say that she cannot hold her husband’s sperm svhich she could have done very
well if she had been well disposed.

The ninth precaution is with regard to a woman, whether she is old or young;
and this you shall find out from what is told yo«. Should she be very old, say that
she has all the evils that old women have, and afso that she has many saperSaieics
in the womb. Should she. horvever. be young say that she suffen from the stomach,
and whenever she has a pain further down, say that it comes from the womb or the
kidneys; and whenever she has H in the anterior part of the head, then it comes
from the stomach; and whenever on the left side, then it comes from the spleen;
whenever to the right, then it comes from the liven and when it is wone and almost
impedes her eyesight, say that she has pains or feels a heaviness m the legs, particu-

larly when she exerts herself. . ,

Th, tenth ptecution: yon mmt loop yonMlt «ry buty sp.mng or J””

nos, and i! the old woman pestm you md. the urine say qu.te mually: mat
concern is this of youtsi" or "IVhy do yoo pester me so much! It she says; -Yes. tt

136

ON THE HISTORY OF MEDICINE

concerns me/ then you shall know the sex If she says no, ask as has been explained
under the fourth precaution

The eleventh precaution is taken with regard to white or yellow wine If you have
any doubts m this respect, be cautious and put the lid of the urinal down and pour
out a little of the content in such a way that the wine in being poured out touches
your Snger Then you must give her the urinal and act as if you were going to blow
your nose whereby you put the finger that has been dipped in on or next to your
nose, then you will smell the odor of wme, whereupon you must take the urinal
again and say to her ‘ Get away and be ashamed of yourself I ’

The twelfth precaution is taken with respect to fluid made from figs and also
nettles Although you could recognize this under the first precaution yet you will
clearly see that the residue extends in the form of a circle touching the urinal and
does not make a rotundity or pine cone like a true sediment
The thirteenth precaution whenever the old woman asks what disease the patient
has you must say * You would not understand me if I told you, and it would be
better for you to ask what he should do And then she will sec that you have judg
ment in the matter and will keep quiet But perhaps she will say ‘ Sir, he is very
hot, therefore he seems to have a fever ’*— • Thus it seems to you and other lay people
who do not know how to distinguish between fever and other diseases '

The fourteenth precaution When you have been called to a patient, feel the pulse
before you examine the urine and make them talk so that the condition of the
animal virtue becomes apparent to you After having recognized these factors you
will be able to evaluate the urine better and with more certainty and you may
proceed thus

The fifteenth precaution is should the patient be m a bad condition so that you
think that he may die the following day, do not go to him but send your servant
to bring you the urine or tell them to bring it to morrow in the early morning
because you wish that they prepare for the meal and that after you have seen the
urine you will tell what they shall administer And so from the report of the penon
who brings the urine you will be able to form an opinion about the patient, whether
he IS m good or bad condition

The sixteenth precaution is that when you come to a patient you should always
do something new lest they say that you cannot do anything without the books
The seventeenth precaution is that if by hard luck you come to the home of the
patient and find him dead and somebody perhaps says ' Sir, what have you come
for? You shall say that you have not come for that, and say that you well knew that
he was going to die that night but that you wanted to know at what hour he had
died

The eighteenth precaution is that if you have a competitor whom you believe to
be a shameless crook be careful when you go to the house of the patient, perhaps he
will stir up the urine for you and you will not be able to form a certain judgment
from It

The nineteenth precaution is the following if two urines of the same patient are
presented to you and you wish to know which was the first ask at what time of the
night he got up, for if he did at dawn or after digestion had taken place that urine
which is more digested and red will be the fint, i£ it has sediment If. however, he

BEDSIDE MANNERS IN THE MIDDLE AGES 137

.got up before midnight or around that time, you may judge that the lea digested
and less red unne is the first *

No other deception can occur outside of these, bur these points znust be kept ia
mind, and you must be cautious because the physician is greatly honored it he knows
nosv to be cautious, for he is asked questions many times.

Note that the physician must be learned in diagnosing, careful and accurate in
prescribing, circumspect and cautious in answering questions, ambiguous in making
a prognosis, just in making promises; and he should not promise health because in
doing so he would assume a divine function and insult God. He should rather prom-
ise loyalty and attentiveness, sbou}d be discreet ia making calls, and he must be care-
ful in speech, modest in behavior, and kind to the patient.

Ill

Physician! IVhen you shall be called to a sick man. in the name of God seek the
assistance of the Angel who has attended the action of the mind and from inside
shall attend departures of the body.** You must know from the beginning how long
the sick has been laboring, and in what way the illness has befallen him, and by
inquiring about the symptoms, if it can be done, ascertain what the disease is. This
is necessary because after having seen the faeces and urine and the condition of the
pulse you may not be able to diagnose the disease, but if you an announce the
symptoms the patient will have confidence in you as in the author of bis health and
therefore one must devote greatest pains to knowing the symptoms.

Therefore, when you come to a house, inquire beiore you go to the sick whether
he has confessed, and if he has not, he should confess immediately or promfse^T you
that he will confess immediately, and this must not be neglected became many ill-
nesses originate on account of sin and are cured by the Supreme Physician after
having been purified from squalor by the tears of contrition, according to what is
said in the Gospel: “Go, and sin no more, lest something wone happens to you."**

Entering the sickroom do not appear very haughty or overrealous, and return, with
the simple gesture, the greetingr of those who rise to greet you. After they have seated
themselves you finally sit down faring the sick; ask him how he feels and reach
out for his arm, and all that we shall say it necessary so that through your entire
behavior you obtain the favor of the people who are around the sick. And because
the trip to the patient has sharpened your sensitivity, and the sick rejoices at your
coming or because he has already become stingy and has various thoughts about the
fee, therefore by your fault as well as his the puke is affected, is different and im-
petuous from the motion of the spirits. ^Vhen it has quieted down on both parts,
you shall examine the puke in the left arm because, although the right side would be
satisfactory, yet it is easier to diagnose the motion of the heart in the left arm on
account of its vicinity to the heart. Be careful that the patient does not lie on the
right side because the compression would hinder the sense motion, nor should he

leXhe text of the first sentence must be cotnipt. Compare the tact of de Rend. op. tit..

which is not too clear ether.

The text should read ’‘promittat" as de Renii has, not “permitut*

18 Sec Paul Diepgen, Die TheologU und dcrttnilichf Stand, Berlin, 1922. p.

Off.

138

ON THE HISTORY OF MEDICINE

stretch the fingers or make a fist While you apply the fingers of your right hand you
shall support with the left the patients arm, because from greater sensibility you
will distinguish the different and various motions more easily, and also because the
patient’s arm being so to say weak requires your support If the arm is very full and
fleshy you must press your fingers hard so as to get into the depth, if it is weak
and lean you can feel the pulse sufficiently on the surface You must examine the
pulse to a hundred beats at the very least, so that you may form an opinion on the
various kinds of pulses, and the patient's people should receive your words as
the result of a long examination of the heart beat
Finally you request to have the unne brought, and if the change in pulse indi
cates that the individual is sick, the kind of disease is still better indicated by the
tirine, but they will believe you to indicate and diagnose the disease not only from
the urine but also from the pulse While you look at the urine for a long time you
pay attention to its color, substance, and quantity, and to its contents from the
diversity of which you will diagnose the different kinds of diseases as is taught in the
Treatise on Urines, whereupon you promise health to the patient who is hanging
on your lips ^Vhen you have left him say a few words to the members of the house
hold, say that he is very sick, for if he recovers you will be praised more for your
an, should he die his friends will testify that you had given him up
Let me give you one more warning do not look at a maid or a daughter or a
wife With an improper or covetous eye and do not let yourself be entangled in
woman affairs— for there are medical operations that exate the helper's mind,
otherwise your judgment is affected, you become harmful to the patient, and people
will expect less from you And so be pleasant in your speech, diligent and careful
in your medical dealings, eager to help And adhere to this without fallacy
IVhen you have been invited for dinner you should not throw yourself upon the
party and at the table should not occupy the place of honor although it is customary
to assign the place of honor to the pnest and the physician Then you should not
disdain certain drinks nor find fault with certain dishes, nor be disgusted perhaps
because you are hardly accustomed to appease your hunger with millet bread in
peasant fashion If you act thus your mind will feel at case And while the attention
IS concentrated on the variety of dishes, inquire explicitly from some of the attend
ants about the patient or about his condition If you do this the sick will have
great confidence in you, because be sees that you cannot forget him in the midst
of delicacies 'When you leave the table and come to the sick, you must tell him that
you have been served well at which the patient greatly rejoices because he was very
anxious to have you well served

If It IS the time and place to feed the sick you will feed him It is necessary,
hos^ever, that you set the time for the patient's meals namely m intermittent
fc^e^s when the sick have a real remission, in continuous fevers when there happens
to be a quiet moment because a decline of their fever does not occur before the
crisis In intermittent fevers they must be fed before the attack and so early that
when the attack comes the entire food be digested, because otherwise nature will
have to fight a war on two fronts and it will not be strong enough to digest what
has been offered at the wrong moment nor will it be able to defeat the enemy disease
\Vhen the attack of fever has begun, wait until it has ceased and then wait for two

139

DEDSIDE MANNERS IN THE MIDDLE AGES

more hours or for one at leajt, because the organs are exhausted from the preceding
battle and the attack of the enemy and do not want that a burden be imposed on
Uiem in the form of food, but after having so to tay triumphed owr the enemy they
wish to have a rest.

You shall feed the sick according to the season of the year and according to the
change of seasons and of the disease; and quantity and quality of food must be
varied according to the diseases, for you shall give the patient ampler food in imer-
miitcnt than in continuous fever, and colder food in a continuous than in intermit'
tent fever, mote food in winter and spring, less in summer and autumn because
tliey stand it very badly. The age must be considered, and you wiil restore chiidren
more often than youths, beause their consumption is greater on account of the
liquidity of the humors and because they muse grow, for it is according to nature
to restore where there is a daily loss- Old people you will restore with less food
because they have little heat and vigor; and also according to what they are accus-
tomed to eat, because if they are accustomed to use an ampler and coarser diet
you wilt not give them the same kind of food but rather prescribe a liquid or moder-
ate diet. You mult fear constipation of the bowels or flux, and if there is flux you
must start out with coarser food such as quinces, soib-apples, and medlars because
they constipate through their thickness. If, hotvever, there is constipation you will
start out with lighter liquid foods. Thus you will give prunes and the cooked juice
of Damascene prunes because they quickly eject through their heaviness. If the
condition of the bowels is between the two. you will begin with a lighter and more
liquid diet because this is very useful to the sick and protects against greater harm.
11 the bowels have moved, give such a diet became it relieves the various organs.
Thus you shall give first prunes cooked in water, or pomegranates or almond milk
that you shall prepare in the following way: almonds removed from the shells shall
be put in hot water, whereupon they shall be ground thoroughly and a little cold
water shall be added: the whole shall be stirred, strained through a clear linen doth
and given to drink. If however a little bread, that is the soli part of it, is cooked in
the pot the almond milk is belter digested than if it is drunk pure. After it has been
prepared, a small amount must be poured off, and then one must remove by blowing
or with a feather the oily substance that is on the surface because it is a hot matter.
After this has been done, give several limes thicken broth to drink or water in
which the soft part of bread has been dissolved.

You shall also give barley flour and make it in the following way: fint wash the
barley In cold water, pour it over a stone and rub it so that it loses the skins,
whereupon it must be rubbed and ground in a mortar or ground between millstones;
then have the finer parts very well cooked and toward the end of the cooking add
a little almond milk and present it to the sick. If, however, you wish to have
ptisane, cook the coarser parts of the barley in water and give him ptisane in a
drink or water in which bread has been soaked, cooked or not. And remember
that while there is food in the stomach you shall not give diuretic water with syrup
because such drinks force the food out of the stomach undigested or retard djgestjon.

Remember, furthermore, that in the beginning of the disease the physician en-
deavors to oppose it with digesUve remedies, for he is the helper of nature and must
aid it. Nature namely proceeds to making the aisls. to the triumph over the disease;

140

ON THE HISTORY OF MEDICINE

she Wishes to reduce the forces of the disease by changing the condit/on and quality
of the matter and by dispersing it among the organs so that the parts be separated
from each other and she may reach her end and more easily than expected with
complete results in one weak expulsion In the same way, the physician m order
to drive out the matter that must be driven out, must be prepared to treat the
digested matters according to tlic aphorism in the fint book of Hippocrates Considera
tion of the cause of the disease determines the choice of remedies that digest the
humors for if the patient suffen from cholera you will give vinegar syrup «f he
suffcn from a cold humor you will give oxymel, and cserytliing else as I have said
in another chapter Ohphysiaan thanks be given to God

SIDELIGHTS
ON THE PRACTICE
OF MEDIEVAL SURGEONS

-a, HERE were different types of surgeons during the latter part of the
Middle Ages. The physicians who were trained in the universities had
surgical knowledge, but it tvas merely theoretical. The physician as a
rule did not perform any manual labor. His task was to examine a patient
and to indicate the appropriate therapy, which was applied by the physi-
, cian’s helpers, the surgeon or the apothecary.

The medieval surgeons were educated as craftsmen and were organized
in the guilds of the barber-surgeons, which were to be found all over
Europe from the beginning of the fourteenth century on. The barber-
surgeons fulfilled a very important function in society. They were nearer
to the people than the physicians. People of some means had their barber,
who came to see them every morning. These barbers not only shaved
their clients and cut their hair but performed venesections at regular
intervals and were the advisers of the whole family in all matters of cos-
metics and personal hygiene. The diseases of the skin therefore belonged
in the realm of the surgeon. When syphilis was observed toward the end
of the fifteenth century, the surgeons were the first to treat the new
disease, and they ^vere the first to apply mercury, which they used for
other cutaneous eruptions.

In the middle of thirteenth century, the College de St. C6me et St.
Damien was organized in Paris for the training of surgeons. It svas gov-
erned by the king’s otvn body-sui^eons, tvho at the same time gave free
consultations in the hospital, the H6tel-Dieu. History knows of many
conflicts between those surgeons of higher training and the surgeons who
merely went through an apprenticeship.

142

ON THE HISTORY OF MEDICINE

"Ot infrequently that surgeons entered medd
sureical physicians, or that physicians acquired pnctical

themnsff * ^ ™’B«’n physicians are responsible for some d

ttrTw , M-ddle Ages Finill,

tions the ° individuals who performed surgical open

pul" ; horT™' over Europe as L

we e moln T" They had no legal status and

^v«e prosecuted quite often, but still could be found in every marie

thirtonth ren't.'.* linown about medieval surgery It is knoivn that in tie
ferprimummteiiTiouem ci'eanh"n"‘* ™ considered the healinj

as to avoid all . Cleanliness was recommended to the surgconio

wme. anf somXrs^t ™P-P’^

eral imoressinn m *u ^ before the operation, the gen

Which It was to retur^ ^ “

evaurg'ieom wdX'rbeh'* ''''

descriptions that are to h/* sickbed of the patient, lEviviJ

surgerywerenotavaiiaKi rr-L”"^ Henn de Mondevtiles treatise oE
of medieval surgeons Henri ^^hghtful sidelights on the practice

studied medicinfr,ii ;^.® Mondeville was born about 1260 He
ested in surgery he wenf? f 'i'“^’ m Pans Inter

surgeon Theodorir a ^ ° became the student of the gre^t

this time was surgeon to MondeviHe a'

lowing the armi« it seems thai"h svith him and fol

in Montpellier and la^ « Save lectures on surgery and anatomy
on which he worked I he began toTompose ins book

on which he worked fnr IT *” began to compose

illness that seems to have becnMbCTcido'sif ’’ P™‘”"‘“^

His treatis tubercu

first edited m the ^otte a few manuscripts andw’a^

translation was made bv ^ excellent French

Mondeville had ^fcfl “

ttttnd He was not afraid to attack even the

*J‘e ChiniTgte des Heinrich von

J L Pagel nebst cmer Abhandli.n.v Male herausgegeben von Df

«chneidCT Berlin 1892 A Hinchwald^T**^ Synorj-ma und einem Glossar von M S'""
iChirurgie de Maitre Hem, rfJ »r . ’ PP

France, composie de 1306 i 1520 fJ^*^*”^** ^fi’nirgten de Phlllippe le Be! Boi
Filix Alan 1893 903 pp par £douard Nicaisc.

ux Alan 1893 903 pp /The nt>mM 1 j “an?aise par £douard Nicaise,
French translaUon) ' P indicated In the text of thu paper refer 1

SIDELIGHTS ON MEDIEVAL SURGEONS

143

Ung. He ^s■n5 ne^•ce married, and congotulated himself on = ^e-

nr^IIc seems lo have had a special antipathy for the ladies of Montpel-

r.o^ounrUArahic —

ahlcesse, and sun ^

section, Mondcville makes ge _ surgery. One is the

There arc two ^tes, “j^^discussing. and the other is practice

theory that one learns by read „ j ion" time. Whoever scants

that one acquires by assist, ng a ^ b, ,faid of evil

to enter surgery must 'ihe an^^^^ >-

smells, he must cut or „„„ knot* how to extract a

how to lie in a courteous way. and. final ).

giftormonq' from , superiority of medicine or

su^JJT—

SurgrTunde"b■'^bi>*"P"J'“ ”;;^'‘;^^l«rf vW medidne h helptes.
cure, mote complim'ed "’•'sdies. „„t by tliemsehes.

2. Sonie,, corn disease, that eaonot ^ , disease so ev.den.ly

not Immune, nor by medicine. Media , ^he doings of sutgenr arc

mat one could say that the mte is bidden, which is very

visible and manifest, while those it is not apparent, and ,1 th^

lor many physicians. If they have made ^ commits an enor while

im he patiem. h will no. he i, seen h, eve^h^y present and

petforming an fnasion on the constitution of the patient,

Lldnotheatuihntedtonatntenotto

The follosving pa,s.iges pves a gtap

surgeon and physician (p- )■ ^ physician has been oiled

. of 2 strictly *orS'“* diseas . J physician will tell the

Even m the case. ;„d pLpous people. They

d'em"'sic h“s ev^en, Uta. the •“^'^V.^^ple.el, ignorant. If here is ariy.

patient. Sir. « > reasoning and are bad and cruel people,

don’t know anything about !

thing they Inow. they got U hotn^ ^ P,htr sidebyon, s

i;'''’'*er”!ide yon, sir, are feeble, inclined

"7a:rf'o;7ndrecels-ehn^i-^*^^^

,o be sicl and delicate, and the esp

144

ON THE HISTORY OF MEDICINE

too much Therefore I advise you in your interest and out of sheer love not to
call for a surgeon and although not a surgeon myself I will endeavor to help you
without them If the sick man accepts and everything goes well all the better
If It goes wrong the physiaan will say to the sick man Sir I told you from the
beginning that I was not a surgeon myself However for the reasons mentioned
and because I felt sorry for you I did w^t 1 have done and did it well and accord
ing to the art and to reason better than any surgeon Cod knows it. Now I am
extremely busy and cannot gne you as much assistance as before and I advise you
to call for a surgeon although this will not cure you more rapidly Then the
physician goes on saying I advise you to call such and such a surgeon He u very
able not arrogant and an honest man He knows his art very well perhaps better
than more famous surgeons Then he brings in a miserable surgeon without
education a nifhan completely ignorant and he does so for four reasons (1) so that
the surgeon cannot check the errors of the physician (2) that he may continue his
surgical treatment and have authority over the uneducated surgeon (5) so that if
necessary he can make the surgeon responsible for his own faults past and future
(4) m order to get llie honor and profit for himself but to leave the mistakes and
shame to the surgeon as the case may be

The surgeons on the other hand did not behave much better (p 100)

If It M a surgeon who is called first, for a purely medical treatment never will a
physician be called on his advice On the contrary the surgeon will do whatever he
can to keep off the physician and this for several reasons 1 The physiaans know
nothing and do nothing to the patients except talk to them and all of them with
out any difference whether the case requires it or not they purge the patieno
2 The surgeons and nature cure such maladies every day without the help of
physicians 3 If you call a physician he will immediately purge the patient whether
It be necessary or not

The different behavior of honest and dishonest surgeons is illustrated
by the following case (p 100)

A rich man has a beginning inflammation He calls a conscientious surgeon who
says Sir so far this is not yet a surgical case because nature does not require
any remedy ^{^cr•e^sf for era? Il ihe.v JMfpens that

the patient calls for a dishonest physician or surgeon If it « a surgeon he will say
immediately Sir you have a very large abscess I feel it inside It I do not operate
on you immediately you arc undoubtedly lost Then the surgeon with attractive
remedies will cause an abscess and will obtain reward gratefulness fame and
honor because he saw a nonexistent abscess that the fini surgeon had not seen And
this surgeon for having said the truth will incur Infamy shame and harm

The question of the fee plays a very important part in Mondeville s
discussions (p 112)

The surgeon who wants to treat his patients properly must settle the matter of the
fee first of all If he is not assured of his fee he cannot concentrate on the case

SIDELIGHTS ON MEDIEVAL SURGEONS

145

He will examine superficially, and will find excuses and delays. If he has received
his fee, things are different. In lach a case, the blind see, the lame run. because
they are bound by the benefits they received.

The surgeon must have five things in mind: first, his fee; second, to avoid gossip;
ilxird, to operate cautiously; fourth, the malady: fifth, the strength of the sick man.

The surgeon must not be fooled by external appearances. The wealthy people
when they go to see a surgeon dress in poor clothes or, if they are richly dressed,
will tell stories in order to reduce the surgeon’s salary. IVlien they find the surgeon
assisting poor people they say that charity is a flower and that the surgeon is
bound to help the poor. But they wilt never admit that they are bound to do the
same. Therefore I told them repeatedly, "You have to pay us for yourselves and for
three people, so that 1 may cure them after I have cured you." But they keep quiet,
and I have never found a man rich enough or, rather, honest enough, whatever his
status, religious or not, who had been willing to pay what he promised without '
being compelled and urged to do so.

Mondcvjlle is fully assrare of the importance of psychologic factors in
surgery. The patient has to be kept in good spirits. His mind must be
diecred, and this can be done by Jiaving musicians play for him or by
promising a quick recovery. The surgeon must not be afraid to He if this
benefits the patient (p. 144). For instance, if a canon is sick, tell him that
his bishop has just died. The hope of succeeding him will quicken the
recovery. Or dreams should be interpreted in such a svay as to have a
beneficial influence on the sick man.

Mondeville’s recommendations may seem unethical to us. They were
not to the people of his time. Nobody would object if a carpenter or a
blacksmith discussed the question of fees openly, and surgery, until very
recent times, a craft also.

IMPOTENCE AS A RESULT
OF WITCHCRAFT

In the majority of all cases impotence is due to nervous causes It is a
phobia The fear of being impotent prevents individuals from having
nonnal erections ‘ It is not astonishing that m the Middle Ages such a
condition was frequently attributed to witchcraft The question was :m
portant because it had legal consequences Inability to consummate
marriage was a reason for declaring it null and void ab inilto
The first who brought up the question of witchcraft in this connection
was Hincmar Archbishop of Rheims who lived in the ninth century In
discussing a definite case he came to the following conclusion ® if a mar
riage has been annulled on account of the impotence of the husband he
cannot marry again if his impotence tvas due to natural (physical) causes
If his condition however was the result of witchcraft and the marriage
had been declared void after the customary treatments had failed he ivas
permitted to marry again

Gratian who in the twelfth century codified canon law accepted Hinc
mar s view and so did Peter the Lombard m the same century m his
Ltber Sentenltarurrij where he has a special chapter De His Qui Male-
ficiis Impediti Coire Non Possunt * Peters book was commented upon
by the leading scholastic theologians*

Since impotence resulting from witchcraft was to be treated not only
was the Church interested in the question but the physicians also In the

ISce Max Marciue in Handuiorlerbuch der Atedtiimschm Psycholope Lcjpng 1920
2 Jacques Paul Migne Patrolog a Lalina vol 126 p 150
8 Lib IV dut 34 tbid vol 192 p 927

4 See Joseph Hansen Zauberuehn Inqu s lion und Uexenproiess im hUttelaller MOn en
und Lcipug Hutonsche S bliotbek XII 1900 p 152

IMPOTENCE AS A RESULT OF WITCHCRAFT 147

eleventh century Constantine of Africa devoted a chapter of his Pan-
techne to it, “De His Qui Coire Non Possunt.”® The same text with addi-
tions tv'as ttTongly attributed to Amald of Villanova and ^vas published
in his Opera Omnia.^ Constantine's text with or without additions is
frequently found in medical manuscripts as an independent anonymous
treatise. It has been published and discussed by Gerda Hoffmann in an
excellent dissertation.’

In my studies on the medieval medical manuscripts of Montpellier® I
found in the fifteenth century manuscript H 277, fol. 60’, a version that is
mentioned but tvas not used by Gerda Hoffmann. This may justify its
publication here, although it follows rather closely the text of other
manuscripts. I am adding an English translation and a fesv remarks on its
content in relation to the Malleus Maleficarum.

TEXT

Incipit libellus de hiis qui maUficiu impediti cum uxoribm suls cohire non possunt.

Sunt quidam qui maleiiciis diabolicis impediU, cum uxoribus suis cobire non
possURt, de quoruoi sulragio Roiumus nostrum librum enudare, quod medicazaentum
ni fallor est sancti'ssimum.

Igitur si hoc alicui contigerit, spetet in domino et ipse dabit benignitatem. Sed
quia maleiicia sunt multimoda, oponet ut de hlls dispuiemus. Malefidorum enim
quedacn de animatis Hunt, ut testtculi galli si sint supposin' lecto oun ipsius sanguine,
efHciunt nc concumbant in lecto lacentes. Quedam karacieribus saiptis ex sanguine
vespertilionis. Quedam vero de inanimatts, ut sicut si nux vel glans separentur,
quarum medietas ex una parte vie, aliera ex aJlera, unde sponsus et sponsa peigere
debent.

Sunt et alia que de grants fabarum conficiuntur, que neque aqua calida molifficantur
nec igne coquuntur, quod maleiiciura pessimum est si quaituot illarum vel In
tecto vel in via vel super hosiium vel infra ponantur.

Sunt et alia que sunt metalica sJeut que fiunt ex ferro vel plumbo, ex ferro sicut
que fiunt ex acu cum qua mortui suuntur vel morlue. Sed quia hec sunt diabolica,
et maxime sunt in mulieribus, aliquando divinis auxiliis aliquando humanis curantur.

Igitur si sponsiis et sponsa supradiais maleficiis contuibentur, sanctius est de hiis
diserere quam silere, quia si non succuraotur, separantur et sic degenerantur, et hoc
malum exercentes, non solum in proximis sed etiam in spiritu saneco peccare
videntur.

s Omnia Opera Ysaae, Lugduni, 1515, toL 117*'.

« Amaldi de Villa Nova Remedia Contra Mateficia, Sasileae, 1585, 129.

1 "Beltrage zur Lehte von der dutch Zauber verunachten Rrankbeft und ihrer Behandlung
in der Median des Mittelalters,” Janus 57:129, 179, 211, 1935.

8See H. E. Sigerist, “Eatly Mediaeval Medical Texts in Manuscripts of Montpellier,- Bul-
letin of the History of Medicxrte 10:27, 1941.

148

ON THE HISTORY OF MEDICINE

Si enim maleScium recte extirpare volumus, videndum est, si supradictura maleG
cium subsic lecto auferatur Sed si actor tstius nialeficii in die auferat et in nocte
ponat \el comeno aliam domum acqmrant sponsus et sponsa ibique laceant
Si karacienbus hoc maleficium fiat, quod cognoscitur quia sponsus et sponsa, non
diligant se adinvicem queraiur supra limen hostii \el infra, et si quid imeniatur,
defleratur ad episcopum sel ad saceriolem, sed si non, fiant ea que inferius ponuntur
Si nux \el glam sint causa hums malefiai, accipiat mulier quandam nucem scl
glandem separetque earn, et cum una medietate pergat vir ex una parte alicums vie
et ibi ponat. mulier vero ex altera parte vie ponat alteram partem mucis, dcinde
sponsus et sponsa accipiant ambas partes nucis testa non extracta et postea sic lota
nux reintegretur et servctur per vn dies hoc facto coheant
Si autem sit propter fabas magis dmnis quam humanis curari potest Si sit propter
acus mortuorum. querantur maleficia vel in fulon® vel in pulvtnari Si non invenian
tur, in altera domo concumbant

Cants fel mascult domum purgat et efficit ut nullum malum medicamcnlum
domui inferatur

Canino sanguine domus parietes aspeige et ab omni maleficio liberabitur
Fel alicuis pissis et maxime zangannl [id est lucii] si sponsus el sponsa secum
habeant m pisside luniperi et cum eunt dormitum ponatur super carboncs vivos et
Inde fumigcntur, omnia supradicta maleficia evanescunu
Similiter si argentum vnum accipiaiur et m calamo canne miitatur, calamo cum
cent et plumbo cohoperto, nescientibus sponso et spoma, m loco nullum malcfiaum
CIS nocebit

Sed 81 pecans imminentibus supradiaa minime profuerunt, accedant ad sacerdotcm
vel episcopum, et si episcopus hoc concessent et nullum remedium invenitur, facu
confcssione ab episcopo vel a religioso sacerdote, in die sancte resurectionis seu
ascensionis vel pcntecostem communicentur Corpore et sanguine dommi accept©*
sponsus et spoma dent inter se osculum pacts et accepta benedictione ab episcopo
vel a sacerdote dec sibi episcopus vcl sacerdos hunc versum profciicum saiptum m
carta Vox domini super aquas dorotnus magnus super aquas mulias** Deinde
veniant domum et a copulacione per tres dies et nodes se cuitodiant, postea rem
agant et sic omnis diabolica virtus destruitur
Expletus est libellus de maleficiis Deo gracias amen

TRANSLATIOS

A short treatise about the people who, impeded by spells, are unable to have inter
course with their vs ives

Tlicrc arc people sslio impeded by diabolical spells are unable to have iniercoune
with tlicir v^ivcs. We do not want to deprive our boot of Uieir appUuse, for the
remedy if I am not wrong ismostsaaed
Now, if this should happen to somebody, he must set hii hope In the Lord an

• Other MSS have “culdira “

10 Palm 28 3 in the \ulgaie:^ S in the King James renion

IMPOTENCE AS A RESULT OF WITCHCRAFT 149

He will be merciful. Since, however, there are many kind* of spells, it is necessary
that we discuss them. Some spells are made of animated substances such as the
testicles of a cock. If they are put under the bed with blood of the cock, they bring
it about that the people lying on the bed cannot have intercourse. Some are made
of letters written with the blood of a bat. Some are made of inanimate substances,
for instance if a nut or an acorn is divided in two. and one half is put on one side,
the other on the other side, of the road along which the bride and bridegroom must
proceed.

There are others also which are made from beans which are not softened with
hot water nor cooked on the fire. This spell is very bad if four such beam are
placed on the roof or on the road or over or under the door.

There are others also which are of metal, such as those that are of iron or lead,
for instance, the iron ones made of the needle with ivhich the dead men or women
have been sewn. And because these spells are devilish and are particularly in women,
they are sometimes cured fay divine, sometimes by human measures.

If therefore bridegroom and bride are disturbed by the above-mentioned spells,
it is better to talk about them than to keep silent, for if the victims arc not succored
they are separated and thus disgraced, and doing this evil they seem to sin not only
against their relatives but also against the Holy Ghost.

If we wish to extirpate the spell properly, we must look out: if the above-
mentioned spell is under the bed. it must be removed. But if the author of this
spell removes it in daytime and puts It back at night, or vice vena, then bridegroom
and bride must acquire another house and lie down there.

If the spell is made of letters, which Is reoagnired by the fact that bridegroom
and bride do not love each other, one must search above and under the threshold
of the door, and if something is found it must be taken to the bishop or priest.
If not, one must do what is indicated below.

If a nut or an acorn are the cause of this spell, the woman shall take a nut or an
acorn and divide it in two. And with one half the man shall proceed on one side
of the road and deposit it there; the woman, however, shall put the other half
on the other side of the road. Thereupon bridegroom and bride shall take both
parts of the nut without having removed the shclL And then the nut shall thus be
made whole again and shall be kept for seven days. Having done this they shall
have xijifrcouTse.

If, however, it happens on account of beans, it can be cured with divine rather
than human means. If it is on account of the needles for the dead, the spells must
be sought either in the pillow or in the mattress. If they are not found, the victims
shall lie together in another home.

Bile of a male dog purifies the bouse and brings it about that no evil remedy be
brought to the house.

Sprinkle the walls of the house with dc^s blood, and it will be liberated from
every spell.

If bridegroom and bride carry bile of a fish and particularly of rangarinus (that
is lucius) along in a box made of juniper, and if when they go to sleep they pour
some on burning coals and are fumigated therefrom, all spells mentioned above
vanish.

150

ON THE HISTORY OF MEDICINE

Similarly if quicksilver is taken and pot into a reed pen and the pen is sealed
■with wax and lead while the bridegroom and bride know nothing about it no spell
will harm them at the place

If however on account of impending sins the above mentioned measures did not
help at all they shall go to a priest or the bishop And if the bishop has permitted
It and no remedy is found after having confessed to the bishop or an ordained
priest they shall take Holy Communion on the day of the Holy Resurrection or
Ascension in Whitsuntide Having received the Body and Blood of the Lord bride
groom and bnde shall give each other the kiss of peace
And after they have received the benediction of the bishop or priest the bishop
or priest shall give this verse of the prophet written on paper The voice of the
Lord IS upon the waten the great Lord is upon many waters Thereafter they shall
go home and shall abstain from intercourse for three days and three nights Then
y shall perform it and thus all diobolical power is destroyed
The little treatise on spells has come to an end Thanks be to God Amen

Impotence as a result of witchcraft was discussed by many scholastic
physicians whose writings have been reviewed very carefully by Cerda
Hofmann

Since witches were considered the chief authors of such evil spells the
Witches Hammer, the Malleus Maleficarum, of 1489 devotes many pas
sages to the question “ Following the Dominican scholar Peter of Palude
who died in 1342 it distinguishes five methods by which the devil causes
impotence “

And as to this Peter of Palude (III 34) notes five methods For he says that the
devil being a spirit has power over a corporeal creature to cause or prevent a
local motion Therefore he can prevent bodies from approadung each other either
directly or indirectly by interposing himself in some bodily shape In this way it
happened to the young man who was betrothed to an idol and nevertheless marrie
a young maiden and was consequently unable to copulate with her Secondly h«
can excite a man to that act or frecre b s desire for it the virtue of secret things
of which he best knows the power Thirdly he can so disturb a man s perception
and imagination as to make the woman appear loathsome to him since he can
as has been said influence the imagination Fourthly he can directly prevent the
erection of that member which 15 adapted to fructification just as he can prevent
a local motion Fifthly he can prevent the flow of the vital essence to the memben
m whicli lies the motive powers by closing as it were the seminary ducts so that i
does not descend to the generative channels or falls back from them or does not
project from them or in any of many ways fails in its function

11 Malleus Maleficarum translated by the Rer Montague Summers London 1928

12 part 1 quest on 8 p 55

151

IMPOTENCE AS A RESUI.T OF WITCHCRAFT

More specifically iritches srere supposed to "impede and prevent the
po^s'cr of procreation” in the following way;**

ExtrimicalJy they came it at times by mesas of images, or by the eating of herbs;
sometimes by other external means, such as cocts' testicles. But it must not be
lliought that it is by the virtue of these things that a man is made impotent, but by
the occult power of devils’ illusiom; witches by this means procure such impotence,
namely, that they cause a man to be unable to copulate, or a woman to conceive.

The Afa/letts Afafeficarum states that "God allows the devil to afflict
sinners more tlian the and in the case of impotence "the infirmity

we are considering can only be due to the sin of incontinence. For, as we
have said, God allows the devil more power over that act than over other
human acts, because of its natural nasnoess, and because by it the first sin
was handed down to posterity/*

The victim of a speil was therefore frequently branded as a sinner. The
remedies were five:**

In conclusion we may say that there are five remedies which may lawfully be
applied to those who are bewitched in this way; namely, a pilgrimage to some holy
and venerable shrine: true confession of their sins with conuitioru the plentiful
use of the sign of the Cross and devout prayer; lawful exorcism by solemn words,
the nature of which will be explained later; and lastly, a remedy can be effected by
prudently approaching the witch. . . .

Johann Weyer, who in his De PrafsiigHs Daemonum, published in
1563, so courageously opposed svitch-hunting, discussed also the question
of impotence.*® He pointed out that such a condition could result from
various natural causes and chat it could also be produced incidentally by
drugs. One should therefore not think of sorcery whenever such a case
occurs, nor accuse innocent people. Weyer did not deny that the devil
could disturb a man’s generative function, but he was most violent in
affirming that the devil would certainly not need the intermediary of
some filthy old wench. He discarded as lies various stories told about im-
potence caused or cured by magical means. In the case of a gentleman
who was cured by anointing himself with bile of a raven and some kind
of an oil after a recipe of the book of Cleopatra,** Weyer’s conclusion

19 Part ii, question 1. chapter 6, p. US.

n Pan U, question 2. chapter 2, p. 168.

15 Part ii, question 2, chapter 5, p. 170. n

i« Book iv, chapter xx.

n Various books on the subject ot gynerology and cosmetics were transmitted under the
Ti s me of Cleopatra, and some of them were printed in the Renaissance.

152

ON THE HISTORY OF MEDICINE

was that erroneous beliefs can harm an individual but can also relieve
him.

Impotence is no longer a mystery, and we can understand the condi-
tion without taking recourse to the devil. Impotence, however, like other
nervous disorders and particularly sexual neuroses, is still a playground
for superstitions and quackery.

HENAISSANCn, BAllOOUJi;, AND AGE OF
ENLI G I ITENM ENT MED I CINE

THE FOUNDATION OF
HUMAN ANATOMY
IN THE RENAISSANCE

we speak of the foundation of human anatomy^ we immedi-
ately remember the names of two great Greek physicians who, at the end
of the fourth and the beginning of the third centuries s.c., lived and
worked in Alexandria— Herophilus and Erasistraius. Their names have
survived the centuries and have become a part of our anatomical nomen-
clature, They tvere not specialists in anatomy, but all-round physicians
whose tmtings cover the whole wide field of medicine. Herophilus was
chiefly influenced by the school of Cos and •wrote famous books on the
pulse, on drugs, on midwifery; but then he also wrote a treatise on
anatomy in at least three books. The fragments preserved show that he
had a thorough knotvledge of the anatomy of the eye, the membranes of
the brain, the genital organs, and the duodenum, and credit is to be given
him for his recognition of the true nature of the nerves. He dissected
numerous animals and occasionally human bodies; according to an an-
cient tradition, er-en human vivisections were performed in Alexandria.

A still greater anatomist was to be found in Erasistratus. Fragments of
his tsvo rvorks on anatomy contain good descriptions of the heart, the
liver, and the brain; it vfa$ he who discovered that there are two kinds of
nerves— sensory and motor. But he went still further. Being a student of
Cnidos, where the tendency had always been to localize disease, he recog-
nized that diseases have a seat, and that this seat has to be sought in the
organs. In his dissections he had found anatomical alterations sv-hich

156

ON THE HISTORY OF MEDICINE

seemed to have some relation to the disease from which the patient had
died

Both Herophilus and Erasistratus founded schools which continued
for many centuries, and it is chiefly due to them that Alexandria was the
of anatomical studies throughout antiquity When, in the second
fnty A D , Galen wanted to study anatomy, he had to go to Alexandria
lus was the only place, he tells us, where you could find a skeleton Hu
man dissections, hotvever, tvcre no longer practiced, and one had to rely
upon what was found by dissecting monkeys, pigs, and other animals
And so there was anatomy long before the Renaissance But it existed
before the Alexandrian school We can trace the beginnings m Greece
back to the sixth century b c , to the schools of the first philosophers all
of whom were scientists as well as philosophers They observed the phe*
noraena of nature and endeavored to draw conclusions from what they
saw, speculating about the primary cause of all things It would have
been surprising had they not extended their studies to the bodies of am
mals

Yet we can go back still farther There was always some kind of ana
tomical knowledge As soon as man began talking in an articulate Ian
guage, he invented names to designate the parts of the body, very much
as a child does Whenever an animal was slaughtered, be it for the
kitchen or for the sacrificial altar, anatomical observations were bound
to occur, and the first classification of organs was probably a distinction
between edible and nonedible parts Primitive man must even then have
been impressed by certain anatomical peculiarities, as was the Paleolithic
man, who, in a cave of Spam, drew the outline of an elephant and within
tlie picture drew a heart Remains of a cosmic mythical anatomy are still
preserved in our language We still call the first cervical vertebra Atlas,
carrying the dome of heaven, the cranium, we still speak of the Adam’s
apple, tlie mount of Venus the labyrinth

■Whenever surgical operations were performed, the surgeon must have
had some kind of anatomical knowledge The earliest surgical book pre-
served, the Edwin Smith Surgical Papyrus, which was originally written
at the time of the Old Kingdom in Egypt, gives evidence of such ana
tomical knowledge Anatomy, therefore, is a very old science, and yet
inaeni anatomy was of a quite different character from the anatomy that
■V2S found at the time of the Renaissance The surgeons’ knowledge, as
Sirs It VNcnt, was topographical It was limited to certain regions of the
bal-T- \s long as surgery vv as restneted to a small number of operations-

HUMAN ANATOMY IN THE RENAISSANCE

157

as ^vas the case dotvn to the nineteenth century— the surgeon could oper*
ate very successfully with a limited knowledge of the human body. An-
cient anatomy, then, was almost entirely animal anatomy. The Alexan-
drians occasionally described human organs, but never in situ and never
systematically. First of all, anatomy bad an entirely different place in the
system from what it has today. One studied the structure of the body be-
cause it was a part of the realm of nature, just as one studied plants or
minerals and geography. A doctor did not study anatomy because he
thought it imperative, and this was because Greek medicine had an es-
sentially different structure from that of our medicine today. The symp-
toms of disease svere not traced back into the organism. The concept of
disease sras not ontological, and, if one systematized, one did not systema-
tize disease but rather, different types of man. Erasistratus has a unique
position in Greek medicine. He took the road that we have followed, but
his attempt to establish an anatomical system of medicine failed, just as
Aristarchus had found no followers for the heliocentric system. Another
school grew out of Alexandria— the school of the Empiricists, who de-
clared openly that anatomy ivas of no use to the doctor. The same view
tvas shared by another very popular school, the Meihodicists. And as the
ancient world grew old Hippocrates became still more the dominating
figure— Hippocrates, who had cured without anatomy.

The foundation of human anatomy, therefore, was the accomplish-
ment of our western medicine. There, a necessity for the doctor to have
an intimate knowledge of the human body %vas ovenvhelmingly felt,
which eventually broke do^vn completely the taboos that surrounded the
human body. The body of a diseased man ivas always considered to be
within the realm of the physician. Not so the cadaver, the attitude
towards tliat being the result of esthetic, ethical, and religious concep-
tions. The cadaver was thought to be something holy, or impure, not to
be touched without necessity. Tfie Christian attitude, contrastingsharply
body and soul, svas by no means favorable to the development of anat-
omy. And yet, in spice of all this, the barriers were broken. From the be-
ginning of the fourteenth century on, human cadavers were dissected,
first in Bologna, then in other universities, and several times a year.
Such anatomies svere held, but th^did not serve research purposes; they
were, rather, mere demonstrations illustrating the textbooks. One tvas
still convinced that the Greeks had knoivn all there was to knoiv about
the human body, and one dissected in order to reach a better undentand-
ing of their statements.

158

ON THE HISTORY OF MEDICINE

The Renaissance marks the turning point in attitude of man towards
anatomy and towards the human body m general The word Renais
sance’ is a technical term from the history of art Used first by Vasari,
It became generally accepted after the publication of Jakob Burckhardt s
classic book Die Kultur der Renaissance tn Itahen (1860) What does
the Renaissance mean to medicine? It certainly was not a revival of learn
ing, for there was learning in the medieval universities Nor was it a
revival of Greek medical literature, for this had been knoivn through
translations from the Arabic since the eleventh century Far more was it
,val of the Greek spirit of research— a netv attitude of man towards
fellow men and the world as a whole Humanity became the ideal of
new society which grew up first m Italy— a humanity that meant the
highest possible development of the personality And whenever strong
personalities come fonvard, the traditional authorities are in danger of
being uprooted One essential feature of the period of the Renaissance is
the discovery of the world, the great world that was unknoivn to the
Greeks new continents, with new plants, new species of animals, new
races of mankind But also the small world, the natural surroundings of
man, were rediscovered One looked at nature with different eyes New
mventones of vegetables and animals were taken, and investigation of
the human body was a part of the great adventure, the discovery of the
world Once more men became aivare of the beauty of the human body,
and they endeavored to represent it m all its natural glory If the medie
val artists as a rule failed to represent the nude body ivith anatomical
exactness, it was not because they had no chance to study it but because
their attitude towards the human body was different In the Renaissance
the artist began to study the body by examining the ancient statues that
were being excavated in ever increasing numbers and by observing na
ture Botticelli s Venus was distinctly inspired by the Medician Venus
that had been unearthed in his time Some artists, however, were not
satisfied with studies in plastic anatomy but wanted to know the structure
of the body under the skin The prince of such investigators was Leo
nardo da Vmci

When in the eighties the anatomical and scientific drawings of Leo-
nardo were made available to the public through the publication of
Richter, a great enthusiasm for Leonardo arose His work was ap
preached emotionally and uncritically, and he was considered the first
real scientist of the occidental world Then followed the studies of Pierre
Duhem on the physics of Leonardo, where for the first time his work

HUMAN ANATOMY IN THE RENAISSANCE 159

studied from a critical standpoint. In endless books, men tried to solve
the riddle of his personality. Most of them made the mistake of measur-
ing him on the tvTong yardstick; Benedetto Croce from the point of view
of speculative idealism, and Olschki from the point of view of modem
positivism. Leonardo has to be studied as a man of the Renaissance; this
has been done in an admirable svay by Ernst Cassirer. Leonardo repre-
sents a type of amateur scientist. He never went through a university; he
was an illegitimate child. He was a strong opposition to the traditional
scholastic science of the time, constantly making sharp distinctions be-
tween the discoverers and mere imitators. His work marks a shifting
from books to the book of nature, from revelations in svords to revela-
tions in works. Mathematics to him formed the very heart of all knosvl-
edge. All knowledge was nothing more than a measuring, and everything
was expressed in proportions. Proportion ivas the medium of recognition,
and proportion ivas not only a logical and mathematical but an esthetic
conception as well. This formed the link between the scientist Leonardo,
endeavoring to investigate nature, and the anisi Leonardo, recreating
nature in his work. Nature is the realm of perfect forms and is ruled by
necessity. The fact that Leonardo admitted to such a concept of natural
laws made him a true scientist. Nature is dominated by reason. Experi-
ence and reason are not contradictions— they are two principles. Experi-
ence reaches its goal in mathematics, just as mathematics bears its fruits
in experience.

Still, the study of man claims the first place in Leonardo’s interest. Man
is the primary object of his research. studies the proportions of the
human body, the plastic aspect of its outlines, but he goes further, strip-
ping the skin, dissecting the body. TTionsands of sketches are the result
of his studies, which were intended for a complete book of anatomy that
was to describe the structure of man from the very moment of his con-
ception. Leonardo knew the medical literature of the day. Quite a few
of his sketches are not the result of observation but illustrate statements
he had found in books. Hottfever, he was never satisfied merely tvith what
he read, but ahvays went further, approached the cadaver, experiment-
ing, dissecting, making notes and drawings.

Leonardo’s anatomical work ivas never finished, and after his death his
drawings were scattered to the vrinds. His whole life work, artistic and
scientific, remained a torso, ivbich is not to be wondered at, since it was
an entire cosmos that he was attempting to recreate. Leonardo is a unique
figure. A man of the Renaissance, to be sure, and yet hard to place in the

160 ON THE HISTORY OF MEDICINE

category of his time He was extremely interested in function, in dynara
ICS, while sixteenth century science was essentially static, and it was only
100 years later that dynamics were attacked by the scientist

The doctors, too, were not idle They, too, found themselves drawn to
the study of the human body Cadavers were now somewhat easier to
obtain, and as early as the beginning of the sixteenth century we find
quite an important group of anatomists who, although still convinced
of the superiority of the ancients, performed a great many dissections
themselves and left good descriptions of certain organs, men like Alessan
dro Achillmi in Bologna, who svrotc annotattones to Mundinus, Gabriele
Zerbi m Padua, Alessandro Bcnedetti, and most important of all, Bercn
gario da Carpi, professor of surgery in Bologna, who also wrote a com
mentary to Mundinus which contained some quite valuable observations

The true founder of modem human anatomy, however, was Andreas
Vesalius a man who from early childhood had felt himself drawn to these
studies At the age of twenty three, he was appointed professor of surgery
and anatomy in Padua Four months after his appointment he produced
his first anatomical atlas, six plates illustrating the skeleton and the ar
tenal and venous systems What made his way clear was the discovery that
ancient anatomy was essentially animal anatomy He understood that the
structure of the human body had never before been described completely
and systematically, that the work still had to be done Vesalius was lucky
in having a very fine artist to assist him At the age of twenty seven he
had accomplished a task that in other people would have represented the
work of a lifetime In the year 1543 the seven books De Corporis Humam
Fabrtca were published m Basel, a great work and a beautiful book of
663 foho pages with more than 300 illustrations An Epitome for teach
mg purposes appeared simultaneously, and this Epitome was translated
into German as a textbook for surgeons by the rector of the University
of Basel, Albanus Tonnus

Vesalius lived to the year 1564, but his work had been done long be
fore that He resigned from the University of Padua and lived at the im
penal court as a body physiaan to the Emperor The inspiration he had
given was strong enough to spread enthusiasm for anatomical studies
throughout the century His chair in Padua was for a long time filled by
people who continued to be the leaders m anatomical study, Realdo
Colombo, well known for his description of the pulmonary circulation,
Gabriele Fallopio, whose Observationes Anatomtcce are noteworthy for
their accuracy, Fabncius of Acquapendente, whose anatomical theater

HUMAN ANATOMY IN THE RENAISSANCE 161

can still be seen at the University oC Padua, the teacher and inspiration
of Harvey; Giiilio Casserio, who wrote a classic book on the auditory or-
gans. Outside Padua, in Bologna, Rome, Naples, and, totvards the end
of the century, north of the Alps, anatomy became a more and more im-
portant object of researdi.

Vesalius' book rvas published in 1543, the same year in rvhich Coperni-
cus’ De Revolutionibus Orbium Ccelestium appeared. In laying the foun-
dation of human anatomy, Vesalius laid the foundation of modem medi-
cine. The year 1548, therefore, marks the beginning of a new era. From
then on, anatomy tvas the iron fundament of medicine. But, more than
this, anatomy became a method of thinking. The history of medicine
from Vesalius to our day is to a large extent the history of the applica-
tion of anatomical methods. Step by step, one held after another was con-
quered by this new method. Physiology at the time of Vesalius was still
speculative and philosophical in character. In the seventeenth century,
anatomy developed into anatomic antmata, and an anatomical physiology
rvas bom, working by means of experiments. In the eighteenth century,
pathology became anatomical. A new ontological concept of disease had
been realized, and disease from then on was attributed and bound to the
organs. One saw that the symptoms of disease are the result of anatomic
alterations in the organs. Diagnosis became diagnosis of the organs; per-
cussion and auscultation were introduced as methods enabling the physi-
cian to observe anatomical changes. The last field that had to be
conquered was therapy, rvhich down to the middle of the nineteenth cen-
tury still followed traditional lines. The final step was taken also and
found its expression in the development of modem surgery.

Today this cycle has come to a certain conclusion; the anatomical
method has been applied to all fields of medicine, and a new, a physio-
logical, era has begun.

PARACELSUS
IN THE LIGHT
OF FOUR HUNDRED YEARS

7 HEN Paracelsus came to Salzburg, four centuries ago, he was only
forty eight years of age but he was an old man, sick, tired, and worn If
you look at the picture that Augustin Hirschvogel made of him three
years before his death, you will notice that this is the face of a man who
had struggled all his life and had become embittered, of a man who had
been fought and derided He had tramped all over Europe, and now he
was nearing his end

Why did Paracelsus go to Salzburg m 1541? He had mitten a great
many books on a great variety of subjects medical, scientific, philosophi
cal, and theological, but he had succeeded in having only a very few
printed Of his major works only one, his Surgery, a book that discusses
not operations but the treatment of wounds and other surgical diseases,
had found a publisher and an audience Now, in the summer of
he had some hope that in Salzburg he would find patrons and would c
able to have a few more of his books issued in print

It was too late, however When he came to the city he was a sick man

Lecture delivered January 23 1941 at The New York Academy of Mediane m
sixth series of Lectures to the Laity 1940 1941 entitled Art and Romance of Median

PARACELSUS AFTER FOUR HUNDRED YEARS 163

On September 21, he felt that the end was near, called a notary, and drew
up his will. An inventory of all his earthly possessions fills hardly two
pages. He had some clothes, a fctv coins, a fesv jesvels, gifts of tvealthy
patients. He bequeathed them to a few friends. His manuscripts he left
to a barber-surgeon. He had always felt closer to the surgeons than to the
academic physicians. The rest of bis possessions he left to the poor. He
had been one of them all his life. Three days later, on September 24,
he died.

IVho was this man? It is extremely difiuailt to give an adequate picture
of him, for many reasons. Many of his books have not been published
yet. In the authoritative edition of Rail Sudhoff,^ fourteen volumes are
devoted to the books on medicine and the philosophy of nature. They
tvere to be foUotved by ten more volumes of theological tvritings, and of
those only one has been issued so far. Paracelsus' theological witings
reflect a very important aspect of his personality, and without them it is
difficult to understand his other books. Paracelsus' language adds to the
difficulty of interpreting his work. The great majority of his books U’cre
not Avritten in Latin but in German, and not in the language of Luther
but in an Alemannic German which is close to the dialects chat are still
spoken in Switzerland today. In the sixteenth century the German lan-
guage was not yet developed to express matters of natural science. A
number of medical books had been translated, mostly in the fifteenth
century, but the majority of them were popular books for the layman or
for the surgeon.* The translations of the Bible by Luther and Zivingli
had enriched the language considerably, but there were no technical
terms available to designate subjects of natural science. Such tvords had
to be coined, and the interpretation of those we find in the works of
Paracelsus is not at all easy.

Another difficulty is that Paracelsus, although a man of the Renais-
sance and a scientist, ivas deeply rooted in German medieval mysticism,
and unless -ive know its literature we cannot attain a full understanding
of Paracelsian thought.*

iKarl SudhoEE. Theophrait von Hohenheim g«i, Paraeelms SSmtUche Werke: I. AbteiJ-
ung. Medlzinische, nalvrwiisenschoftlKhe und philotophiseht Scriften, Munich. 1922-193S.

14 volumes.

2 Kail Sudhoff. Deutsche medhinische Inkunabetn, Leipzig, 1908. {Siudien zur Ceschichte
del Meduiti herausgegeben. von der Puschmann Stiftung an dcr Univcnit3t Leiprig. Heft
2/3.1

8 See the excellent study of Bodo S. FreilieTr von Waliershausen. Poroeebus am Eingang
der deutschen Bitdun^gesehichte, I^ipw’g. 1936.

164

ON THE HISTORY OF MEDICINE

1 would like to locate Paracelsus in space and time, and I think that
this will help us to draw a more vmd picture of his personality. Let me
take you to Switzerland If from the city of Zurich— "hortus deliciarum,
nobile Turegum”— you follow the left shore of the lake, you will come
to a mountain, the Etzel From the top of it you have a superb view of
the snow and ice-covered peaks of the Alps, and to the east, right at your
feet, you see a lovely rolling landscape with hills, woods, pastures, and
orchards In the sixteenth century, however, most of the region was
covered with forests Passing the Etzel, a pilgrims’ road leads through to
the Benedictine Abbey of Our Dear Lady of Einsicdeln It had been
founded in the ninth century, had developed into a cultural center, and
was a famous place of pilgrimage where a Black Virgin was ivorshipped
A fire once had destroyed the monastery and church, through a miracle
the statue of the Virgin was not burned but it turned black Before you
come to the abbey you cross a wild gorge through which a mountain
river, the Sihl, flows m cascades A tvooden bridge crosses it, and right
at Its entrance stands a house whicli is an mn today and was one in the
fifteenth century To this place a young physician came late in 1491 or
early m 1492 His name was Wilhelm Bombast von Hohenheim Hetvas
the impoverished scion of a noble family of Suabia As he had to make
a living, he studied medicine, probably in Tubingen, and came to Swit
lerland to practice He married a girl from the region, a member of the
Ochsner family They both came from the same Alemanmc stock, a
sturdy race of hard working people, fighters who made excellent sol
diers They were not 'woven of silk as Paracelsus once said, but ‘of

coarse linen ’’ They had the unrest and curiosity common to many moun
tain people ^Vhen you groiv up with a mountain in front of you, the
moment invariably comes when you want to know what is beyond it
Some day you climb it, and then you see other valleys and more moun
tains And you go on and on until you reach other lands This has driven

many Siviss into foreign services and beyond the seas

Dr Bombastus von Hohenhcim settled doim near Einsiedeln and
practiced on the pilgrims’ road Two hundred thousand pilgrims still
wonhip the Black Virgin annually They come by tram today, but in the
fifteenth century they followed the road that crosses the Sihl They a
passed the doctor’s house, and many of Uiem, weary and sick from long

traveling, must have called on him

Toivards the end of 1493, two years after he bad started his practice.
Dr. Wilhelm \on Hohenheim had a son bom to him His Chrutian

PARACELSUS AFTER FOUR HUNDRED YEARS 165

name was Philip. But the father was a humanist, a keen botanist, and so
he gave the boy in addition the name of Theophrastus, in memory of the
student of Aristotle. "iVhen the boy grew up, he was blond and used to
be called "Goldilocks" which in Latin 1$ Aureolus. And so it happened
that Paracelsus would sometimes call himself with full names Philippus
Theophrastus Aureolus Bombastus von Hohenheim. Later, after having
studied in Italy, he followed the humanist fashion and adopted the Latin
name Paracelsus. IVhat it actually means we do not know.

This is the setting in whiclt the young Paracelsus grew up, a landscape
that seems lovely to us today, but svas awe-inspiring wilderness then with
its steep rocks, dark forests, and long rvinters tvhen the tvhole region was
buried in snosv. He grew up close to nature, btJt as a subject of the abbey
also close to the church, fascinated and puzzled at times by its services
and rites.

Paracelsus svas born in 1493, the year tvhen Columbus returned to
Spain after having discovered a new world. It was a period of awakening
all over Western Europe. The medieval world tv'as a static world. Man
was bom into a status from which tt svas hard to escape. It was an authori-
tarian world, dominated by the Church. Salvation was the purpose of
man’s life, and all other considerations were secondary. It was the best
possible world created by God for all time to come, and all aspects of life
were dominated by authorities. This world, however, that seemed so
firmly established began to crumble, and in the fifteenth century an atti-
tude of revolt against authorities gradually developed. Trade increased,
and people became wealthy who did not belong to the privileged classes.
Feudalism began to disintegrate; the manor system declined. More and
more free people svere employed, working for wages. Guild masters be-
came merchants. All this created a great demand for gold as a medium of
exchange, and this in turn started the great voyages of discovery. They
were not undertaken to satisfy an intellectual curiosity, but for com-
mercial purposes, because the world needed gold and spices and other
raw materials that rvere not found at home. A new economic order began
to develop, svhich called for free trade, free competition, free initiative,
and appealed to the individual in roan. Such a world could not develop
under the rigid regulations of the Middle Ages. The traditional authori-
ties were opposed. The most porverful authority, the Church, was "re-
formed." The authority of the guilds that regulated all aspects of in-
dustrial life fvas broken. The authority of the medical faculties, svhich
regulated the profession of medicine very much as the guilds controlled

166

ON THE HISTORY OF MEDICINE

industry, was equally opposed Doubts were expressed concerning the
words of Aristotle, Galen, Avicenna, ivhose authority had been unchal
lenged during the Middle Ages The discovery of the world became a
great experience New continents, new races of mankind, new species of
animals and plants, and new diseases were found of which there were no
descriptions in the ivrmngs of the Greeks

Paracelsus thus ivas born m a period of expansion, discovery, and re
bellion His early training was different from that of other physicians
His first teacher was his father, who not only taught him to read and
ivrite but made excursions with him to study plants and animals and
minerals He took him along to the sickbed of patients Together they
explored the nature that surrounded them Paracelsus remained deeply
attached to his father throughout his life He knew that the father would
understand him ivhen the whole world was deriding him In the Grosse
IVundarzney he remembers his early teachers ' First Wilhelmus von
Hohenheim my father who has never abandoned me, Bishop Erhart and
his predecessors of Lavanttal, many abbots of Sponheim ”

In 1502 the family left Einstedeln and moved to Carinthza where the
father became municipal physician of the mining toivn of Vilhch There
has been some speculation as to the reasons why Wilhelm von Hohen
heim should have left Emsiedeln I think the explanation is very simple
The pilgrims were poor, and so were the uoodchoppers tv'ho hied m the
region They needed a doctor, to be sure, but could not provide a living
for him Paracelsus’ father, like all physicians of the day, avas eager to ob-
tain a salaried position that avould guarantee him a minimum income
And this he found in Villach where he remained until the end of his life
There avas a Benedictine abbey in that neighborhood too, the Abbey of
LaNanttal, avhere the young Paracelsus could get instruction But there

jyJb.vf.bJbe used to

spend much time acquiring cxpencncc m chemistry such as few people
and certainly no phjsician had He avanted to be a doctor like his father
and ncaer felt any hesitation about it, but in order to be a doctor he had
to go tlirough the regular curriculum of the schools It seems likely that
he studied the arts at the University of Vienna and medicine m Italy, at
the Uniaersit) of Ferrara His chief teachers avere Manardus and the
great Imm'inist Leoniccno avho avas a rebel also and had avritten a book,
Plintt ac Plurtum Altorum Auclorum Errores Notati We know
little about this period of Paracelsus life, but from later statements in
his uTitings avecan safely conclude that his university years were a bitter

PARACELSUS AFTER FOUR HUNDRED YEARS 167

disappointment to him. He who had studied science in the fields, in the
woods, and in mines, who iiad been in touch with patients from his early
childhood on, found the universities still imbued with tlie spirit of
scholasticism. The books, not nature, were in the foreground in all in-
vestigations. Anatomical studies were undertaken, but Vesahus had not
yet appeared on the scene. Clinical instruction had not yet been inaugu-
rated, not even in Padua. Nfost of the teaching svas theoretical and con-
sisted of the interpretation of texts. The ancient theories of disease were
still accepted, and treatment followed traditional lines.

Paracelsus at this time was already too much of a personality to let
himself be forced into the traditional pattern. If the universities could
not teach him what he svanted to learn, other people svould. Who?
Barber-surgeons, old women, craftsmen, miners, abbots, scholars, or lay-
men. What difference did it make? You must learn from any source that
you can tap. He realized, hou’ever, that he tcould have to travel, and from
Italy he set out on a journey svhich with short interruptions was to con-
tinue all his life and u'hich only death brought to an end.

Paracelsus mentions in his works many places visited on his peregrina-
tions, and this allows us to reconstruct his travels to a certain extent.
After having been all over Italy, he went to France, Spain, and Portugal,
to England, Scotland, and Ireland, to Denmark and Sweden, then east
to Lithuania and Poland. He visited Hungary, Rumania, and Croatia,
was on the Greek islands of Rhodes and Samos, and went as far as
Constantinople, Crete, and Alexandria. He covered an enormous terri-
tory, considering the means of communication of the time. And while he
traveled he practiced medicine, learned from every source, and taught a
fetv young people who followed him at times. He never missed a visit to
mines or mineral springs. Wherever he went, he inquired about the
diseases peculiar to the region, talked to tlie local doctors, to the sur-
geons, to plain folk, but he could also hold his own in discussions with
bishops and scholars. He learned a great deal during these years of wan-
dering, saw a great variety of diseases, learned to observe them under
varied conditions, became asvarc of the great influence of the environ-
ment on man. And he also learned to apply new treatments. He devel-
oped his osvn therapy.

In the sixteenth century diseases were treated primarily svith drugs.
The pharmacological principles of Galen based on the theory of qualities
were dominating. Physicians applied the Galenic materia medico that
had been enriched considerably with Arabic drugs. Compound remedies

168

ON THE HISTORY OV MEDICINE

very often had twenty or more ingredients Paracelsus opposed this poly
pharmacy and pointed out that in sudi remedies one drug neutralizes
the other His recipes were simple, consisting of few drugs He was
always anxious to find what we call today the effectiv e principle His ex
penence in the field of chemistry led him to apply metals and other min
eral drugs He made extensive use of compounds of sulfur, lead anti
mony, mercury, iron, and copper He used such potent drugs as opium
very frequently Many of his remedies did not fit into the Galenic theory,
ivhich to him ivas a proof that the theory was wong and that the action
drugs must be explained on different principles It is hard to tell
whether experience drove him to apply gold, pearls corals, and similar
remedies, or whether this was the result of his astrological views *

Paracelsus undoubtedly ivas a good doctor ivho got results where others
failed He was a better doctor than most of his contemporaries because he
followed two great teachers, expeuenlta ac ratio Observation and correct
reasoning are still the basic methods of medicine Deeply rooted in the
Middle Ages, Paracelsus was nevertheless a man of the Renaissance who
revolted against the traditional authorities Not perscruiamtnt scrtpluraf,
but perscruiamtnt natures rerum In other words, medical research
should not consist of the exploration of books and their interpretation
according to Aristotelian logic, but should be scientific research
Paracelsus wanted to be more than a good practitioner He wanted to
understand things Why is there disease in the world? What causes dis
ease? What is disease? Why does a man wither and die? "Why does a man
become insane? What is man? Paracelsus travels treats patients, reflects
on what he sees and writes about it He did not wite in Latin, which was
a foreign language Whoever thought m Latin thought m the traditional
terms of scholasticism Paracelsus thought m his mother tongue, Aleman
me German, and ivrote in the same language And when he did not have
a term available to express what he meant, he made new terms Some of
his ■writings svere ivTitten for surgeons and had to be m the vernacular,
but his theoretical vrritings in which he addressed himself to everybody
were witten in German also

The most inspiring book that Paracelsus ever isTOte is the Volumen
Paramirum He worked on it for many years, completed it around 1530,
but It was not published before 1562 It is the ripest fruit of Paracelsian
thought, a philosophy of medicine as challenging today as it ivas then It

4 Henry E Sigerul laudanum in the WoiVs of Paracelsus SuUelin of the Hfstory of
Medtane 9-5tQ

PARACELSUS AFTER FOUR HUNDRED YEARS 169

is not easy to read, and a good English translation should be made of it. It
is svritten in the terminology of the day, but if we take the trouble to
interpret it the book impresses us as very modern.* The Volumen Para-
mirtim discusses llie five spheres that determine man's life in health and
disease. Man is a microcosm. He is in small srhat the ssorld is in large.
The sforld is God and nature, and so is man. It sre trish to understand
man, ^ve must study God and nature.

The first sphere is ens astrale. "Wltat does that mean? The stars move
according to eternal laws, so does man's life. The constellation char*
aclerizcs a given moment. Every individual has his moment, his historical
time which affects Ins life in health and disease. This is a very fine
thought. A child bom in Spain today will be exposed to more and differ-
ent diseases than a child bom in 1900. A patient suffering from perni-
cious anemia or pneumonia has better chances of recovery today than he
had twenty-five years ago. In other tvords, the historical moment at which
we live has a great influence on our physical life, and Paracelsus expresses
this symbolically by speaking of the stars.

Man is a pan of nature. He lives in a given physical environment from
which he derives the matter and cnei^ required to sustain his life. But
from nature come also poisons and all the abnormal stimuli that cause
disease. Everything that comes from nature, therefore, is both good and
evil, is to man food, poison, and remedy. It is the dosage that determines
its effect. This is the second sphere, which Paracelsus called ens veneni.

Altliough contemporaries in the ens astrale, no two individuals are
exactly the same. We know that no two individuals have the same finger-
print, or the same handwiting. Each man is born with a nature of his
own and thus carries to a large extent hi$ destiny within himself. This is
the third sphere, ens naturale.

Like animals man has body and mind. They are one and determine
each other mutually. But then man is an animal of a special kind. He is
conscious of himself and of his past. He not only feels pain but is able to
reflect about the phenomenon of pain and to establish abstract concepts.
That which gives man his special position in the world is the spirit. Man
is a spiritual being and from this fact, from the fourth sphere, ens spirit-
uale, may also result causes of disease.

These are the four spheres that determine man’s life. This is the four-
fold order under tvhich he lives. When he is ^vell adjusted to it, he is in

6 The finest interpretation of the Volumen Poramfrum is that of J. D. Achelis, PaTacelsus
Volumen Paraminim, Jena, 1928.

170

ON THE HISTORY OF MEDICINE

good health, but from these four spheres may come diseases, and man
then returns to the normal condition in the fifth sphere, the sphere of
God, ens Dei

In other witings Paracelsus explained more specifically the material
process of health and disease The human body does not consist only of
four elementary humors, blood, phlegm, black and yellow bile, nobody
will deny their existence, but they do not play the part attributed to them
by the Galenic school What is important is that in every organ three
principles can be found, the combustible, the volatile, and the incom
bustible, ivhich remains as an ash Paracelsus named these three prin
ciples sulfur, mercury, and salt And to the force that makes an organism
alive, the vital principle, he gave the name archaeus.

From the feiv remarks just made, it becomes apparent that Paracelsus
was a vitalist and spiritualist A deeply religious man, he was basically a
mystic But he was a scientist as well, belter versed m chemistry than
most of his contemporaries, and in his system he endeavored to combine
spmtualism with modem science It was a time that was aiming at com
plete systems that would explain all phenomena of life m health and
disease It had not yet learned the self imposed limitations of modern sci
ence It refused to admit that there were things m nature not yet knoivn

The doctrine of Paracelsus was new and very different from that of
traditional medicine It was in sharp opposition to the scholastic doctrine
More and more Paracelsus felt that he had a mission to carry to the world,
that medicine must be "reformed ’ and that it was his task to be its
Luther He felt a strong desire to settle doivn, to have his books printed
and to teach— to teach regular students and not the vagabonds who had
accompanied him at times on his ivandermgs, many of whom had come
to a bad end In 1524 he went to see his father m Villach and then estab-

lished practice m Salzburg He had hardly started when the Peasants
Wars broke out Although he was not directly m\olved his sympathies
were all with the rebellious peasants He avas arrested, released but there
avas no staying m Salzburg He moved on to Strasbourg a city famous for
Its printing houses and for its school of surgery, situated m the heart of
Europe He applied for citizenship there and avas registered on the
Burger s Roll at the end of 1526

Strasbourg avas not far from Basle, m those days a center of humanistic
studies avith a university and publishers of aaorld reputation attracting
artists and scholars from far and avide There avas much traffic betaveen
tlie tavo cities, and the reputation of Paracelsus soon spread to Basle Not

PARACELSUS AFTER FOUR HUNDRED YEARS 171

one of Ills books had been printed so far, but rumor spread very rapidly
in tliose days, and Paracelsus seems to have been kno^vn particularly for
liis successful treatments of surgical diseases and gout. It happened that
the great printer Frobenius had been suffering for five years from the
result of an accident. Gangrene bad developed in his right foot, and the
physician recommended an amputation. He decided to take a chance and
to consult the new doctor. Paracelsus came, treated him, and saved his
foot. At that time, the humanist Erasmus of Rotterdam svas living in Fro-
bcnius’ house. He was in poor health also, and he too was successfully
treated by Paracelsus.

Upon the recommendation of these two influential men the Totvn
Council offered Paracelsus the position of municipal physician that had
just become \’acant. This was the same kind of job that his father was
iiddiiig in Viiisch. Ther^ jjos however; sinc^ Parle ri’as

a university city, the municipal doctor tvas at the same time professor in
the medical faculty of the university.

Thus suddenly Paracelsus saw his most ambitious dreams fulfilled.
His svanderings were coming to an end. He would be able to teach young
students, to train (hem in die new ‘’reformed” medicine that he had
created. Being close to Frobenius, he would undoubtedly soon have an
opportunity to see his books printed. He accepted eagerly and u^ent to
Basle in 1527. On June 5 of that year he announced his courses. He had
die announcement printed, and not only posted it for the information of
students in the customary way but sent it out to a number of colleagues.
Indeed, it was not the usual announcement of traditional courses, but the
program of a new medicine. It was, moreover, the first Paracelsian words
that ever went to print. I cannot resist the temptation to quote a few
abstracts from this program, as it beautifully reveals the Paracelsian atti-
tude: The art of medicine, he said, had decayed. "But we shall free it
from its worst errors. Not by following that svhich those of old taught,
but by our otvn observation of nature, confirmed by extensive practice
and long experience. ^Vho does not know that most doctors today make
terrible mistakes, greatly to the bann of their patients? Who does not
know that this is because they cling too anxiously to the teachings of
Hippocrates, Galen, Avicenna, and others?" 'What the doctor needed was
a profound knowledge of nature and its secrets. "Day after day I publicly
elucidate for t^^o hours, with great industry and to the great advantage
of my hearers, books on practical and theoretical medicine, internal med-
icine, and surgery, books ivritten by myself. I did not, like other medical

172

ON THE HISTORY OF MEDICINE

vnriters, compile these books out of extracts from Hippocrates or Galen,
but in ceaseless toil I created them anew, upon the foundation of expen
ence, the supreme teacher of all things If I tvant to prove anything, I
shall not try to do it by quoting authorities, but by experiment and by
reasoning thereon If therefore, my dear readers, one of you should feel
the impulse to penetrate these divine mysteries, if svithin a brief space of
time he should want to fathom the depths of medicine, let him come to
''■* at Basle, and he will find much more than I can utter in a feiv words
express myself more plainly, let me say, by way of example, that I
not believe m the ancient doctrine of the complexions and the hu
mours, which have been falsely supposed to account for all diseases It is
because these doctrines prevail that so few physicians have a prease
knowledge of illnesses, their causes, and their critical days 1 forbid you,
therefore, to pass a facile judgment upon Theophrastus until you have
heard him for yourselves Farewell, and come with a good will to study
our attempt to reform medicine Basle, June 5, 1527 "

This was indeed an unusual document and a regular challenge to the
medical faculty The professors were prejudiced against him anyivay
They had not been consulted when he tvas called, and considered him an
intruder According to the custom of the time, he was invited to present
his credentials, but he had no diplomas to show He must have lost them
during his wanderings Paracelsus did not make it easy for the faculty
to accept him During his many years of traveling he had dei eloped hab
Its that were shocking to respectable professors He did not ivear an
academic goivn and a doctor's bonnet, but used to go around with the
broad nmmed hat of a coachman that Holbein has depicted in his por-
trait He drank hcaiily, used coarse language, and did not behave at all
like a professor

In an atmosphere of hostility he began his lectures ivith keenest en
thusiasm He lectured during the summer term of 1527, during the holi
days, and during the winter term of 1527-1528 He stuck to his program
and did not interpret the Greek and Arabic classics in the customary way
He lectured on pathology and therapy, on the preparation of remedies
and their prescription on diagnosis by means of the pulse and the urine,
on cathartics and phlebotomy, wounds and surgical diseases The medical
lectures he gave m Latin, the surgical ones in German, although he was
addressing medical students This too was a shocking innovation

The faculty had taken up the challenge and had forbidden Paracelsus
the use of their lecture hall But the Toivn Council, his patron, backed

PARACELSUS AFTER FOUR HUNDRED YEARS 173

him and the use o! the lecture hall ivas granted. The hostility of the
faculty he could bear. This rvas to be expected. A reformer is prepared
for struggle and does not expect sympathy and cooperation from the
people whose doctrines he is reforming. His hope was in the students,
in the young medical generation. They represented the medicine of the
future; they would understand his message and ti'ould carry his teaching
all over the world. But here Paracelsus met with the most bitter disap-
pointment. The students did not understand him either. They sided
with the faculty against him. They also svanted to be respectable physi-
cians some day. One morning a lampoon ridiculing him rvas found on the
doors of some of tlic churches and on the new student bourse. From the
content it became obvious that it could have been svritten only by one
of his own students. Paracelsus was deeply hurt; he asked the Torvn
Council to protect him and to punish the culprits. It was a sad sight— a
reformer burning with zeal to carry his students along with him yet
forced to ask the authorities to protect him against these very students.

Paracelsus felt deeply discouraged. Frobenius, who had always pro-
tected him, had died, and outside the Totvn Council he had no friends.
A scandal soon brought the situation to a climax. Paracelsus had treated
and cured a canon of the cathedral. He was a rich man and was charged
a rather high fee. Paracelsus, who had never owned anything and whose
patients ivere mostly paupers, followed the custom of the day and charged
rich people fees. The canon refused to pay, brought the matter to court,
and won his case. This was the end. The battle was lost. Paracelsus had
no friend left in the city of Basle, no audience that would listen to him.
Without taking leave from anybody, he left the city in February, 1528,
and began his wanderings once more, a lonely and defeated man but
convinced more than ever of the significance of his mission.

He went where he had come from, into Alsace, to Colmar. In Basle he
had worked feverishly in the preparation of his courses and had accumu-
lated endless notes; some of them were worked out into books, but first
of all he felt the need of justifying his teachings before himself and the
world. He did it in the book Paragranum, I do not know svhat the title
means. Paracelsus liked mysterious names beginning svith para, such as
Para-granum, Para-mirum, Para-celsus. The book deals with the four
pillars of medicine. It is written in aggressive, passionate language. “I
treat of the principle from which I rvrite, that principle without which
no doctor can advance. Therein I have laid myself so bare that my heart
shall at last be revealed for what it is.” “You must follow me and not I

174

ON THE HISTORY OF MEDICINE

^ou . . ho\s do )Ou like Cacophrastus? This dirt you must swallow at
an) rate "

The first pillar of medicine is plulosoph>, b) ishich Paracelsus docs not
mean the traditional scholastic philosophy of the Middle Ages but the
science of nature, wlnt m the serenteenth century rvas still called the
"netv philosophy” Who could be a better preceptor than nature her
self? ’ ‘As then the physician should grow out of nature, what is nature
but philosophy, and what is philosophy but invisible nature? ’

Tlic second pillar is astronomy Heaven is to the creature what a father
IS to his son Heaven works in us, and we cannot understand mankind

unless we recognize its cosmic subjection and its time The third pillar
1 $ dicmisiry Throughout hts life Paracelsus vs as an ardent chemist, and
never traveled without a set of diemical apparatus He gave chemistry
a new purpose, which was not to create gold or silver or the elixir of hfe,
but to prepare effective remedies and to reveal biological processes ‘ Na
ture IS the arch-dicnust and vve must imitate her, otherwise we are no
more than kitchen sluts ” In other words, he had a clear conception of
the fact that many biological processes arc nothing but chemical reac
lions The fourth pilhr of medicine, finally, is virtue The foundation of
medicine is love No man can be a good physician unless he has a highl)
ethical concept of his mission

Since Paracelsus could not spread his gospel by word of mouth, he hid
to do It in writing, and in the following years he worked feverishly put
ting his experiences on paper He wTote a hrge number of monograplu.
one on diseases o! miners, the first monograph on the subject, another
book on mental diseases, studies on gout and other diseases of metaboUsm
as wc would call them He wrote a large number of pharmacological
Ixvoks in vshich he described his remedies and how to prepare them He
WTOtc on the treatment of wounds and other surgical diseases, a subject
in which he wais partiailarly experienced He viTotc on mineral water*
and ihe ainiivc power of Iicalih resorts But as a WTitcr, loo he was bit

terly disappointed Publishers refused to print liis books Numberg, one
of liie most cnhghicneti and progressive cities at the time, was the only
place v»herc lie succeeded in having some of Ins writings published
There, a short treatise of eight leaves on the treatment of syphilis with
guauc wood was publtshcd m 1529, and m 1530 the same publisher,
i-ndench Peypus, pubhstied liis monograpli on syphilis Tlic disease
w-ai widespread m those days and literature asas VNclcomc In
celsus published, somewhere in Suitrerland. a short treatise on the bat u

PARACELSUS AFTER FOUR HUNDRED YEARS 175

of PfafcR, U'aters that were famous in the treatment of syphilis. The
Ntirnberg publisher ^s'as willing to issue other works of Paracelsus, but
the medical faculty of the University of Leipzig protested and discour-
aged him from proceeding with the plan. Only one of his major works,
the Grosse Wxindanney, was published in his lifetime. It was a great
success and was printed several times, in Ulm in 1536 and in Augsburg
the same year. All his other great books, however, Paragranum, Para-
tnirxim, the books on tartaric diseases, and the pharmacological witings
never found a publisher during his lifetime. They became known to the
world much later, when some of his followers, primarily Adam von Bo-
denstcin and Johannes Huser, collected whatever manuscripts they could
find and published them. Huser’s edition of the collected works, pub-
Ibhed in Basle from 1589-1591, is still one of the most useful editions,
with which ss’e must svork as long as tlie Sudhoff edition has no indices-
^Ve know very little about the period from 1528 to 1541, the thirteen
last years of Paracelsus’ life. He was in St. Gall in 1531 where he met
the great humanist Vadianus. It may be that once more he played with
the idea of settling dotm, but nothing came out of it. St. Gall was upset
by religious struggles and Paracelsus did not stay long in the city.

During those years Paracelsus went through a deep religious crisis. He
svas too much of a mystic to follow the Reformation, but too much of
a nonconformist to accept the integral doctrine of the Catholic Church.
For a number of years we have no records of his life. All we know is that
he w'as in the mountain region of the eastern part of Switzerland, and
that during those yean he wTOte most of his theological witings, ex-
amining and discussing in his own way the basic principles of the Catho-
lic Church.

For a svhile it looked as if he had given up medicine entirely, but when
an epidemic of plague broke out in the Inn valley the physician in him
•was challenged. He came back to earth, took up the fight again, svrote a
plague book for the city of Stemng, and once more he took the pen to
justify himself and his teachings before the world. He did it in seven
splendid Defensiones, his most personal work, which reveals his per-
sonality better than anything he had svritten before.® He continued his
itinerant life, practicing and svriting until he returned to Salzburg. There
he died and was buried in the church of St. Sebastian.

■VVliat is the significance of Paracelsus in the light of four hundred
years? ^Vhen we compare him to other great physicians and surgeons of
«An Englijh translation of the DefenHones by Mn, C. Lilian Temkin is in press (1941).

176

ON THE HISTORY OF MEDICINE

the Renaissance, men like Vesalius, Fracastoro, Far^, we find that hw
contribution was of a totally different kind Vesalius created a new de
scnptive human anatomy which became the foundation of a new system
of medicine The work of Vesalius has been assimilated by medicine and
IS dead noiv The same applies to Fracastoro and Par^ Fracastoro wrote
a classical monograph on contagious diseases We know that most of his
observations were correct They have been accepted m course of time
and much has been added to the subject since then Par^ became the
father of surgery We venerate him as such, but if we read his works we
do it for purely historical reasons

Paracelsus holds a totally different position in the history of medicine
Like the others, he too made a number of definite contributions to medi
cine and improved its equipment and techniques, particularly m the
field of therapy He will always be remembered for the introduction of
many chemical remedies But he did infinitely more m that he attacked
the basic problems of the healing art, asking for the how and why He
was a scientist in search of a philosophy of medicine He used the expen
ences of medicine and science as materials m order to create a synthesis
He wanted to understand the world m which he was living and mans
part m it m health and disease His approach to the problems was that of
a vitalist and spiritualist Descartes was soon to show that there is another
approach that leads to far reaching conclusions

Whether we agree with Paracelsus or not, we cannot read his books
Without being strongly stimulated or challenged The problems he dis
cussed are not solved yet, and this is why his books are still alive today
They make us realize how primitive and sketchy our present theory of
medicine is We have accumulated a large number of scientifically estab
lished facts They are very useful and are largely responsible for the
progress of medicine But we need a philosophy to connect the facts This
IS Wnere'f'aracdxsus— anil ’Descartes— can stifi teacti us a great iftrJi

178

ON THE HISTORY OF MEDICINE

It was a chance experience that induced Par^ to experiment with
onions The episode took place in Piedmont around 1537 Par^, at that
time a young surgeon of twenty seven years, was attached to the army of
the Marshal de Montejan in the third war between Francis I and Charles
V He relates his experience in the following words ®

< me of the Marshall of Afontejan hi$ Kitdim boyes fell by chance into a Caldron
being even almost boyling hot I being called to dresse him, went to the next
^ to fetch refrigerating medicines commonly used m this case there was
by chance a certaine old counirey woman who hearing that I desired medi
cines for a hurne perswaded mec at the first dressing that I should lay to raw Onions
beaten with a little salt for so I should hinder the breaking out of blisters or pustules
as shee had found by certaine and frequent experience * ^Vbe^efore I thought good
to try the force of her Medicine upon this greasy sculhon I the next day found those
places of his body whereto the Onions lay to bee free from blisters but the other
parts which they had not touched to be all blistered

The result was striking but Par^ did not draw any conclusions from a
single observation Soon thereafter however, he had another opportunity
to treat a serious bum, and the result fully confirmed his previous ob
serration ®

It fell out a while after that a German of Monte/an his guard had hii fiasque full
of Gunpouder set on fire whereby hu hands and face were grievously burnt I being
called laid the Onions beaten as I formerly told you to one half of his face and to
the other half I laid medicines usually applyed to burnes^ At the second dressing I
observed the part dressed with the Onions quite free from blisters and excoriation
the other being troubled with both whereby I gave credit to the Medicine

This was a convincing experiment, but Pard was not satisfied yet and
continued his experiments When dunng the same campaign the castle
of Veillaine ivas taken by storm a number of soldiers were burned by a
tram of gunpowder Pard treated some of them with chopped raw onions
to which some salt had been added and the others with the traditional
ointments Again the difference was striking, and from now till the end
of his life, Pard was convinced of the value of onions in the treatment of

STAff tVoriifs of that famous CMrurpon Ambrose Party translated out ot Latine and
compared with the Trench by Th Johnson IxMidoa X6S4 p 410

♦ The French onglna] tcri is much more picturesque le deaunday i ladite viedte
autrefou I avoit expenmentd eKe me lura en son largon Si mess^ a la fe de Dt" Osuvret
Computes d Ambrone Pari patj T Malgaigne Fans 1B40 vol 11 p 128

s Johnson op at p 410 Malgalgne op at vot iZ p 128

*The onginal French text says "i la motui du visage" while the English transIatiM
made from ihe Latin tramlaUDn has lo the middle of the face I have corrected
translation after the original texc

PAR£‘S ONION TREATMENT OF BURNS 179

bums 7 He said repeatedly that, if a cataplasm of onions could be applied
to a bum immediately, it would prevent the development of blisters and
ulcers and thus lead to a much more rapid recovery.

But now Par^ felt that he should explain the action of onions on bums,
and this was not quite easy. According to Galen, onions were hot in the
fourth degree and the pharmacological principle usually applied at that
time was contraria conlrariis curantur. Fortunately it was with Galen as
it is with the Bible. If you searched long enough you could ahvays find a
passage that would lend authority to your thesis. Pare was convinced of
the effectiveness of his treatment, and the purpose of the theoretical ex-
planation tvas merely to confirm his experience. He reasoned in the fol-
lowing way:*

If any endevour to gainesay the me of this remedy by that principle in Physicke,
which sayes, that contraries are cured by contraries, and therefore affirme that Onions
according to the authority of Galen, being hot in the fourth degree, are not good for
combustions: let him know that Onions are indeed potentially hot, and actually
moyst, therefore they rarifie by their hot quality, and soften the skinne by their
actuall moysture, whereby it comes to passe that they attract, draw forth, and dissi-
pate the imprinted heate, and so hinder the breaking forth of pustles: To conclude,
the fire as we formerly noted, is a remedy against the fire. But neither are diseases
alwayes healed by their contraryes (saith Galen) but sometimes by their like; although
all healing proceede from the contrary, this word contrary, being more largely and
stricktly taken; for so also a Phlegmon is often cured by resolving medicines, which
healeth it by dissipating the matter thereof. Therefore Onions are very prohiable
for the burnt parts, which are not yet exulcerated or excoriated.

This theoretical explanation is not important. ^Vhat counts is that
Pard found a treatment of bums which the experience of a lifetime told
him was effective.

Park’s works, tvritten in French, translated into Latin, English, Ger-
man, Dutch, Italian, and Japanese, were widely read and exerted a great
influence upon surgery. It is, therefore, no wonder that other surgeons
in the sixteenth and seventeenth centuries applied Park's onion treat-
ment of bums. A few examples will suffice to demonstrate this.

William Clowes (ca. 1540-1604). one of the best Elizabethan surgeons,
published in 1591 A prooued practise for all young Chirurgians, concern-
ing burnings with Gunpowder, and woundes made with Gunshot, Sword,
Halbard, Pike, Launce, or such other. The book begins with the grue-
some story of two gentlemen who were drying gunpowder in a brass pan,

1 La Milhode de Traicter les Playes Faictn par HaeijuebuUs. Paris, 1543. fol. 52.

« johnsoo, op. cit., p. 450; Malgaigne. op.

180

ON THE HISTORY OF MEDICINE

stirring it carelessly with their hands until * the pouder upon a sudden
became on fire, wherewith they were most greevously burned, both hands
and face, and also their bodies, and their clothes were set on fire, which
caused them to make a most lamentable crying ' Clowes was called and
applied to the parts that were blistered particularly the hands and face,
three times a day for four days, a remedy the composition of svhich was

Silwcicm ^ %%

Succl Opae § ziu
Misce

The remedy, in other words, consisted of four ounces of onion juice m
which half an ounce of salt had been dissolved Where the ' skmne was
burned off and the parts made rawe am! paynfull Clowes did not apply
the onion juice but one of the traditional ointments The cure was fin
ished without blemish or signes of any burnings '

In another passage® Clowes uses onion juice combined with hnseed-oil
or varnish

Rec Sucacepae g ti
Olei Imi vet or Vamuh g i
Misce

Clowes was familiar with Par6 s work and quotes him repeatedly It is,
therefore, very likely that he learned the onion treatment of bums from
him

In the seventeenth century this treatment was still m common use
Richard Wiseman (1625 1686), surgeon to four kings of England men
tions u m the AppendtK to the Treatise of Gunshot Wounds that he
mote particularly for the benefit of the ' Sea Chirurgeons, who seldome
trouble their Cabbins with many Books It contained a chapter De
Ambustis, or, Of Burns with Gun powder, etc specially written since
‘ Burning by Gun powder and other materials do too frequently happen
at Sea Discussing the general treatment of bums he says

The Indications of Cure are two lunds viz cither by Refrigerants to bath or
anoint the Pari unul the Heat be off and the Eschar separated and then to digest
and Cicatrize or by calefactive Medicaments to relax the Skin and resolve and disi
pate It which by accident will asswage the heat and Burning The Refrigerants are
aq solani plantag hyoscyaiD lac ebotyratuni and all the cooling Juices and Vn
guents as unguent album nutntum populeuta rosat etc These must be used warm

8 Op cit p 4

18 Richard Wiseman Several ChirurpcaJ Treetues ed 2 London J686 p- 440 The fin
edition was published in 1676

PARfi’S ONION TREATMENT OF BURNS

181

until the He 2 l and Pain cease, or the fire be taken out, (as the common expression
is;) else they will rather cause Pain. Hot Medicaments asssvage the fiery Heat and
Pain by Rarefaction. ■\Vhich in the fint place may be done by the holding a burning
hot Iron or Fire to the Part: So whilst the Fire calls forth that Fire it made, it be-
comes its Alexiterium. But the common remedy is, to apply Salt and an Onion beaten
together. But this is not to he done after the Blisters are risen, nor by any means
where the Part is raw; for so you will exasperate the Pain, and increase the InSam-
mation.

The greatest German surgeon of the period, Fabricius Hildanus
{1560-1634) was a strong adv-ocate of the onion treatment of bums.^^ He
used it invariably for bums in the first d^ree in order to prevent the
formation of blisters. He gives several interesting case histories, one of
^vhich concerned his otvn Avife who once burned her right hand in boil-
ing soap. He always had good results with the treatment. His recipe was:

Raw onions, 1)4 ounces

Salt

Venetian soap, 1 ounce each.

Mix in a monar and make an ointment Vidth
rose-oil and oil of sweet almonds.

Fabricius xvamed that the ointment should not be used on the face
since it affected the eyes.

I have no doubt that one could find many more passages on the subject
in the surgical literature of the period, but they would probably be a
mere repetition.

The onion treatment of bums tvas gradually given up when the phar-
macological theories of Galen were abandoned. Surgery, like medicine,
become more scientific, and remedies the effect of which could not be
easily explained in current scientific terms were dropped. This happened
more than once,

In 1923 1 published a new edition and a German translation of Ambroise
Park’s treatise on gunshot -urounds.** ^Vhen you translate such a book you
come to kno^v its author very intimately, and the more I knew of Pard
the more I admired him. I was greatly attracted by his frank, unbiased,
experimental approach, by his honesty, and by his modesty. In the intro-
11 D« Guilhelmi Fabricii HUdani Wund-Artzney, Fnackfurth am Mayn, 1652, pp- <92.
1190-1192,

18 Ambroise Pari, Die Behandiung der Schusstrunden (1545), Klzssiket der Xtedian, Leip-
zig. 1925.

182

ON THE HISTORY OF MEDICINE

ducticn to the book I discussed his onion treatment of bums m some
detail because it illustrated beautifully his entire mode of thinking and
acting I also strongly felt that such a man was not a fool and that a treat
ment that he applied and constantly found efficacious could not be a mere
superstition I thought that it would be worth rvhile to investigate the
treatment more closely and talked about it to my surgical colleagues
"ome of them listened politely and smiled ironically onions m surgery-
historian’s ideal Others were less polite and did not listen at all
And then soon thereafter, in 1925, Edward C Davidson introduced the
tannic acid treatment of burns The reports were so promising that there
seemed to be no need for other methods Then came the treatment ivith
gentian violet and other antiseptics, then came the sulfa drugs There
really was no need to think of onions
The present war ivith its mines and flame throwers has made the treat*
ment of bums one of the most important problems of war surgery It was
found that all existing treatments had great shortcomings,^* and the Cir
cular Letter No 15 of January 11, 1943, from the office of the Surgeon
General of the U S Army gave first place to the treatment with boric
acid ointment, emphasizing the importance of firm pressure especially in
bums of the hands and face It seemed that we had reverted to treatments
used in the last war

But notv, quite recently, news was received from the Soviet Union
about some very interesting experiments performed— with onions Pro
fessor B Tokm of the Tomsk State University and his co workers A G
Filatova, A Kovalenok, and I V Toroptsev found that a paste prepared
from a small amount of freshly macerated onion emits volatile substances
ivhich ivithin a few minutes kill yeast protozoa, and bacteria exposed to
them ” The chemical nature of these substances has not been determined
as yet, and Tokin tentatively designated them as phytoncides, or plant
bactericides They were also found to emanate from ^rlic, radish, mus
tard, and similar plants but are particularly strong in onions Interesting
results have already been obtained in the treatment of infected wounds
In the light of these experiments of Soviet scientists, Par^ s experience
with onions acquires new significance, and I think it would be worth
while to examine whether the onion phytoncides, whatever they may be,
have any action on burns

13 National Research Council The Treatmeot ot Thermal Bums The New
Journal of Medicine 229 817 823 1943
USeCilmencan JlevieiK o/Soviel AI«<finneI0) 236 250 February 1944

PARfi’S ONION TREAT]VfENT OF BURNS

183

And so, after twenty years, today again I would like to draw the atten-
tion of my colleagues to Ambroise Fare's onion treatment of bums. It
may be that he was ■wrong but it may well be that he -^vas right, and it
would not be the first time that empiricism had preceded science in the
history of medicine.

WILLIAM HARVEY’S
POSITION IN THE HISTORY
OF EUROPEAN THOUGHT

- ■■ .. ■

Ji. HIS year the medical world is celebrating the memory of a man who
was bom S50 years ago, and who 300 years ago, in Frankfurt am Mam,
had a small, unpretentious book published which brought about a turn
mg point in the development of scientific medicine and biology This
was the English physician William Harvey who, in his Exercitatio Ana
tomica de Motu Cordis et Sanguinis tn Animahbusj described the circula
tion of the blood

If the discovery of the circulation of the blood had only signified the
solving of a medical problem or the correciing of a centuries old error,
then I would not have chosen it as the subject for my speech However, a
much larger question of cultural history is involved The problem of the
movement of the blood illustrates the profound change taking place m
scientific medicine from antiquity to modem limes The discovery of the
circulation of the blood also shows with particular clarity how the gen
eral attitude of a period influences all creations of the mind and pene
trates the most remote fields of human knowledge

Much has been said and -written about Harvey His discovery has been
praised in gloiving irords And, as everyivhere ivhere real greatness is
found, here also smaller minds were not lacking who, m pointing out

Speech delivered on July 7, 1928 at the ceremony of the founding of the UniverJit?
Leipag

WILLIAM HARVEY AND EUROPEAN THOUGHT 185

Harvey’s precurson, tried to diminish his contribution, to deny him any
originality, even to accuse him o£ plagiarism. As i£ every discovery did
not have its precunorsl As if every discovery ^vas not hovering in the air,
anticipated and half-recogniied by many, and yet fully realized and
formulated for the ages only by one man.

It is not my task here to add my voice to the many who this year are
praising Harvey. That is not necessary. Instead I will try to evaluate
Harvey’s position in the history of European thought and to clarify his
contribution in the light of his period’s concept of the svorld.

Speculations about the nature and significance of blood can be found
early and are probably much older than we can prove. Even to primitive
man certain substances must have seemed vital: nourishment, Avhich he
gained through hard labor, air, which he inhaled and exhaled as long as
life existed, but also blood, which esaiped from ^vounds and which ^vas
found eveT)nvhere in the body.

Long ago, also, the heart must have aroused particular attention as the
organ which tvas located in the middle of an organism and svas in con-
stant motion, a motion which, cither softly or wildly beating, ac-
companied all emotions and stopped only with death. The Paleolithic
fresco of an elephant with a mysterious heart in his interior proves that
primitive man svas concerned with the heart.

All physiological speculations originated from these viul substances
and attempted to find relationships between the substances of the ex-
temal world, nutrition and air, and blood, that vital substance of the
inner ivorld.

We find the beginning of such a theory in the ancient Egyptian doc-
trine of the vascular system and more concretely svith the Greeks. For
Aristotle the heart is to the body what the sun is to the cosmos. The
heart is the source of bodily heat, the origin of the vessels, and the seat of
the reason. It is the puncium satiens, the most vital point, which develops
first in any organism.

In late antiquity sve finally find Galen’s well-developed theory, which
remained in effect for 1500 years until Harvey disproved it. This theory
is not to be found in any one of Galen's writings; in antiquity physiology
did not exist as a special and separate science. We have to search for his
theory in his various svritings, and we are not the first to undertake this
search, for we follosv in the steps of the physicians of the Middle Ages and
the Renaissance. This theory is as follows: the digested food moves from
the colon through the veins into the liver and there is transformed into

186

ON THE HISTORY OF MEDICINE

blood Nourished by spirttus naturaliSf a principle ^vhich we would say
conditions the vegetative functions the blood flows partly into the entire
organism, partly through the vena cava into the right half of the heart
Here the blood stream divides one part flowing into the lung and dis
charging the residues of the organism, the other part oozing through the
septum of the heart into the left half of the heart At this point important
transpositions take place The blood mixes with the air, which hai
reached the heart via the lung and the veins of the lung The collision of
these two substances creates the spirttus vttalts, a principle which to our
Way of speaking controls the animalistic functions During this process
which can be compared to burning, bodily heat arises which in turn is
regulated by breathing The blood which flosvs into the whole organism
from the left half of the heart via the aorta is entirely different from the
blood of the veins, which carries another principle and contains air Part
of this blood flows into the brain and is nourished by a third principle,
the spirttus animalts, ivhich reaches the body via the nerves and fulfills
the nervous functions

The movement of the blood was not thought of as flowing m one di
rection, centrifugally, but rather as flowing mysteriously back and forth
The current of Eunpos was taken as a symbol for this movement This
channel between the island Euboa and the Greek mainland, in which the
current in mysterious ways and seemingly without reason changed its
direction sometimes several times within an hour, was a phenomenon of
nature which had greatly intrigued the imagination of ancient scientists,
and which was scientifically explained only a few decades ago

If we regard this theory in its entirety, we find that it is very logically
constructed It explains much It explains the difference between arterial
and venous blood and between inhaled and exhaled air It provides in
sight into the relationship between food, air, blood bodily heat and the
organism It recognizes blood as the carrier of all vital substances

A characteristic of this theory is that it is purely qualitative and de-
scriptne No attempt is made to measure the qualities The concepts of
number and time arc foreign to u We are confronted with a scientific
way of thinking which is totally foreign to us The Middle Ages and the
Renaissance maintained Galen’s theory of the movement of the blood

In the sixteenth century a profound change took place in scientific
rocdicmc, a cliange which was personified in the figure of Andreas
Vesalms, the founder of human anatomy Ancient anatomy had been am
raa! anatomy Now one was confronted with the enormous task of jn

WILLIAM HARVEy AND EUROPEAN THOUGHT 187

vestigating the basic structure oE the human body, a task which became
the program for the entire century. Speculative anatomy, which did not
query the form but rather the meaning of the organs, and ivhich had
played a very significant role in antiquity and the Middle Ages, now gave
way to descriptive anatomy, the task of which ivas to describe tactually
the shape, construction, and position of the organs. Such studies turned
the thought o£ the times to more Ibctual, tangible objects.

In Padua, the working place of Vcsalius, a school of anatomy tvas
founded which for generations was directed by important minds. But also
in Bologna, Rome, and Naples men worked feverishly on the solution to
the great problem. Toward the end of the century the igniting spark
crossed the Alps, inspiring minds.

During these anatomical studies the structure of the heart and the
organs became better knoiyn, and, because gradually a beginning was
made at organic and mechanistic thinking, doubts arose about the cor-
rectness of Galen’s theory. According t© Galen the blood should flow
from the right chamber through the pores of the septum into the left
chamber. But these pores could not be found. They did not exist. In
antiquity, also, nobody had seen them. But that did not prevent their
supposed existence, because they had to be there, because the system dc*
manded it. Now, however, such suppositions began to be opposed, al*
though only very timidly.

The sixteenth century relinquished tlje problem of the movement of
the blood. This resignation rvas expressed by Fracastoro, one of the
most brilliant men of the century, when he said that the movements of
the heart were knosvn to God alone. The problem ss'as simply not topical.
The thought of the whole century had been static. The structure of the
body had been studied, and, as in the case of the Greeks, philosophical
speculations had been undertaken concerning its function.

In the seventeenth century this conception changed radically, and so
we come to William Harvey.

Harvey was bom in 1578 in Folkestone. Biographically significant is
the fact that at nineteen he moved to Padua and svorked there for three
years as a pupil of the anatomist Fabririo d’Aquapendente. He had en-
tered the circle of anatomists in which the tradition of Vesalius ^^•as being
kept alive. Returning to his native land, he devoted himself to the prac-
tice of medicine, and in IG15 made professor of anatomy at the Col-
lege of Phpicians in London. A lecture manuscript of tliis j’car shows
that already in 1615 he had a pretty clear picture of the circulauon of

188

ON THE HISTORY OT MEDICINE

the blood But another thirteen years passed before he dared to make his
discovery public In 1628. 300 years ago, his work appeared Let us look at
It more closely

In appearance this work did not seem at all revolutionary At first sight
Harvey appears a thorough Aristotelian Aristotelian is his evaluation of
the heart, his comparison of the heart with the sun m the cosmos or with
the monarch of a state His theme is taken from scholasticism Natura
nil facit frustra ’ Every assertion is proved rationally but must also ong
^nate from inspection, sensu patere For this purpose he dissected many
animals and, more important, many species of animals And the result of
these investigations is as follows

Any one who grasps the exposed beating heart of an animal in his
hand will feel that the organ draws itself together and becomes hard
Contrary to accepted belief, this contraction of the heart, the systole, is
the active phase of the heart movement During the systole, blood is
driven into the arteries this causes the beating of the pulse Intensive
study of the valves of the heart clarified the significance of the auricles
(which had not been clearly known in antiquity) and the direction of
the blood stream in the various parts of the heart
Already before Harvey s time the lesser circulation had been dis
covered and with it the fact that all the blood flowed from the heart into
the lungs and back again into the heart Colombo, Vesalius’ second sue
cessor in Padua, had described the lesser circulation of the blood, and it
had been mentioned before his time, a mention lost in the midst of a
theological tract, the Chrisltantsmi Restitutio, by Miguel Servctus, a
physician and theologian who was burned by Calvin Harvey could verify
this discovery It was indeed true that all the blood flowed through the
lungs But what else? From the left chamber of the heart the blood was
forced into the body via the aorta And then what happened to it?

An entirely new way of speculation set in Harvey estimated the
amount of blood ejected by the heart during systole at two fluid ounces
If the heart beats seventy two times a minute, then in the course of an
hour this means 72 X fiO X 2 ^ 8640 fluid ounces That is three times
the weight of the body Where does this enormous quantity of bloo^
come from? From food? By incessant new formation? The figures make
that impossible Where does the blood go? Into the tissues? This likewise
IS impossible There could, then, be no other possibility than that the
blood must get out of the arteries into the heart and the only possible
channels iverc the veins The next step was to prove that the blood stream

•WILLIAM HARVEY AND EUROPEAN THOUGHT 189

in the veins flowed only in one direction^ only in a centripetal direction.
By simple grips o£ the hand, by laying a finger on the superficial veins of
the arm, and by close observation, it was possible to show that the valves
of the veins, which Harvey's teacher Fabricius had described so minutely,
were actually so arranged as to make a centrifugal flow of the blood
impossible.

The circle svas complete now. The circulation of the blood had been
discovered. From the left side of the heart the blood flows through the
arteries into all parts of the organism, makes its svay through gaps in the
tissues (the capillaries were discovered only later) into the veins, then
through the right auricle of the heart into the ventricle, from there
through the lung into the left auricle, and back into the left ventricle.

Harvey ^vas content iv'ith this fundamental discovery. He passed over
such problems as the significance of inhaled air, the origin of bodily
heat, and so on, for he recognired that for the moment they were in-
soluble. He did not try to establish a complete, closed system and was
satisfied to describe what he could prove by direct observation. Therein
also lay his greatness and hb originality.

If we compare Galen's theory of the movements of the blood with
Harvey’s, we see two totally diverse worlds. The ancient theory is quali-
tative. This theory was based on experience and arrived at by reasoning.
Harvey’s theory, ho^vever, was based on quantitative observation. The
conception of time, -which was foreign to Greek science, v/zs introduced
here, and an attempt ^vas made to explain biological phenomena accord-
ing to length, size, and time. Greek science never tackled dynamic prob-
lems, and change, as Dingier* authoritatively proved, U’as not the sub-
stance of scientific investigation. Now, however, thinking was applied to
change, and so the problem of the movement of the blood could be
solved successfully.

Harvey’s method is the experimental method. In antiquity experi-
ments had occasionaiiy been made abo, but these experiments were out-
side the sphere of science and rvere of a descriptive and qualitative na-
ture, whereas the experiments of the seventeenth century -were causal and
quantitative. Harvey’s experiments were extremely simple, even primi-
tive. But this does not prevent his method of rvork and of questioning
nature from being experimental.

In the hands of Harvey, anatomy took on a nerv shape, became ano

rHugo Dingier, Das Experiment, tein IFesen und seine Cesehichte, Munich, J928;
Stephen dlrsay. ■‘Time-Implied FuncUon: An Historical Aper^u." KyMos 1:52-59. 1928.

190

ON THE HISTORY OF MEDICINE

tomia antmata, became physiology The functional idea was incorporated
into medicine Harveys wuing marked the beginning of a new era in
scientific medicine His method is still our method today

We must not be satisfied with this conclusion Now that we have sur
veyed our material ue must try to detennine Harveys position in the
history of European thought Why is it that the functional idea pene
trated medicine precisely at the beginning of the seventeenth century?
Why not earlier? ^Vhy not later? What were the influences of the period?
I In the sixteenth century a fundamental change occurred in the general
attitude toward the u'orld The relationship betireen the individual and
ins universe changed and this new world outlook found its expression
first of all in art The neiv art, which developed gradually in the second
half of the sixteenth century and unfolded completely in the beginning
of the seventeenth century, ivas the art of the baroque Heinrich
Wolfilm^ tried to understand this new style by analyzing its fundamental
forms and comparing them to classical art He showed how the classical
painter composed his pictures m a linear, closed, unified manner, whereas
the baroque painter dissolved everything in motion, making his pictures
three-dimensional Tlie baroque artists broke through the limits of cir-
cumscribed forms-unity became multiplicity, and outlines became
blurred, steeped in chiaroscuro These works of art demonstrated two
entirely different ways of regarding nature, two entirely different world
concepts On the one hand men saw the perfect, the complete, the finite,
the tangible, and on the other hand motion, the becoming, the infinite
The baroque man is interested not m being but in becoming The
baroque is infinitely more Uian a style m art It is an expression of a
manner of regarding the universe, which at that time was reiealed in all
fields— in literature, in music, m fashion, in the state, in general living
and also m science

Coming back to medicine, we become aware that anatomy, precisely
that field of endeavor which occupied the minds of the sixteenth century,
had as its subject a perfect, finite, tangible, and harmonically proper
tioned substance ^^Ic phjsician who, m the first half of the sixteenth
century, looked with the c)es of a scientist at a human being w’as fas
cinatcd by the structure of man and fell compelled to smd> the structure
m Its completeness and harmony The physician who looked at the hu
man body 100 >cars later acted quite differently To him applies what

Sllclnnch WClI’ljn Kunst/’fSfhUhthche Grundbegn[Je, Das PTobUm der StilentvnM>t”t
firtiM AuMi ed C Munich 1923

WILLIAM HARVEY AND EUROPEAN THOUGHT 191

Wolfflin said about the artist: that he did not see man’s eye but rather his
vision. Not the limited body but the unlimited movements of the body
and its parts fascinated him. He did not see the muscle but the contrac-
tion of the muscle and its effect. And so originated analomia antmata,
physiology. The object of physiology is movement. Movement opens the
door to the unlimited, the infinite. Every physiological problem leads to
the source of life and opens vistas into infinity.

Harvey is the physician in whom the baroque concept ^vas first in-
corporated. In medicine he is die man who first formulated this new idea.
He svas an anatomist svho sasv not only the form of the body but its
motion. His experiments stemmed not from the structure of the heart
but from pulse and breathing, the two fundamental movements which
exist in the human being as long as he is alive.

Harv'ey did not just write on the circulation of the blood. are in-
debted to him for another significant work, a work in embryology. Em-
bryology, the study of the development of the fruit in the maternal body,
is another form of dynamic anatomy. The theme of embryology is like-
wise movement, change. And so Harvey remains a dynamic thinker.

Of coune this new form of physiology presupposes anatomy, just as
baroque art follows classical art. It is obvious that Harvey also had his
precursors, and that the whole development ivas gradual. But it was
nevertheless Harvey who gave a conscious form to this new outlook.

For these reasons physiology and the functional idea in medicine are a
product of the baroque. Harvey resembles men such as Michelangelo and
Galilei, the latter expressing a very similar change from static to dynamic
thinking in the field of physics.

The functional idea in medicine pervaded die entire seventeenth cen-
tury and a good part of the eighteenth. One can speak of baroque medi-
cine without any scruples. Anatomy is pushed into the background. The
leading medical schools, the schools of the latrophysicist and the iatro-
chemist, were entirely dynamic m nature. Symptoms of life and disease
svere searched for in movement.

Anatomical investigations did not cease in the seventeenth and eight-
eenth centuries. Science, as opposed to art, utilizes progress and does not
exclude an earlier way of thinking. Medicine was functional in the
baroque period but anatomical studies were continued, though they
were not topical and remained in the background.

Anatomical and functional ideas, static and dynamic thought in occi-
dental medicine, have superseded each other periodically. Toward the

192

ON THE HISTORY OF MEDICINE

end o£ the eighteenth century anatomy again gained the upper hand
only to be supeneded in our day by functional thinking
The history of the circulation of the blood like the history of science
in general, and the history of medicine in particular, demonstrates the
close alliance ivith the history of culture The history of a medical prob-
lem can never be considered as an isolated factor but only in closest con
nection ivith other sciences, only on the territory of a universtlas
hlterarum

A BOERHAAVE PILGRIMAGE
IN HOLLAND

September 8, 1738, Hennan Boerhaave wote to Dr. Mortimer,
Secretary of the Royal Society, the following letter:^

It h a year since age, application, and immoderate fatness have produced an utter
ineptitude to any kind of exercise in such a heavy corpulent body, full of inert hu-
mours, and upon the least motion gasping for breath, with a pulse strangely irregu-
lar; but the most urgent symptom was the interruption, or stoppage of respiration on
falling asleep, and the prevention of any rest by a sudden terrible sensation as of
strangling. Upon which the abdomen and all the paru below it became dropsical; but
notwithstanding the removal of these symptoms, there remain pain of the belly with
great weakness and anxiety, a suSocating asthma; short are my slumbers, disturbed
with dreams, the mind is incapable of any busine»; wearied with this conflict 1 gain
no release, yet patiently wait the divine pleasure to which I am wholly resigned.

Two tveeks later on September 23 between four and five o'clock in the
morning he passed away. He tvas in his sixty-ninth year and tvould have
reached the age oE seventy three months later. When he died, Holland
lost its greatest physician and the whole of Europe its clinical teacher.

It was obvious that the two-hundredth anniversary of the death of

Read before the Johns Hopkins Medical Khtoty Club on November 14, 1938.

1 “Ex Epiitolis Nonduzn Edith Analecta.” in W. Surton, .4n Account of the Life and
Writing! of Herman Soerkaave,ed.Z, London, 174ft pp. 215-216, 69-70.

194

ON THE HISTORY OF MEDICINE

Boerhaave would not pass unnoticed, and indeed the Senate of the Uni
versity of Leiden, the Dutch Medical Association (Nederlandsche Maat
schappij tot Bevordering der Geneeskunst), the Dutch Medical Journal
(Ttjdsckuft voor Geneeskundc), and the Dutch Society of the History of
Medicine, Science, and Mathematics invited the Dutch physicians to a
formal exercise in the University of Leiden and to an excursion to all the
places where Boerhaave had lived They invited, in addition representa
tives of the four countries upon which Boerhaave had exerted his greatest
influence Germany (Professor Paul Diepgen), Austria (Professor Karel
Fredenk Wenckebach), Scotland (Professor John D Comne), and the
United States (Henry E, Sigenst)

These two days will remain unforgettable to all who had the pnvilege
of attending the celebration Europe was in a turmoil with every country
mobilizing troops, but Holland seemed an island of peace The organi
zation of the meeting was perfect in every respect, and the committee
seemed to control even the weather, which can be very nasty at this tune
of year It was warm still, and in the morning a silvery mist was seen
hanging over the flat land and the canals until the sun appeared and
tinted the country with tender colors The last flowers were fading m the
fields

On the morning of September 23 we came together in Leiden, Boer
haave’s city, ivhere every comer, every stone, carries his memory The
formal exercises were held m the Great Hall of the university hospital
which IS the core of the Boerhaave Kwartier, the new medical center, a
campus that includes all departments of the medical school The tneffl
bers of the Leiden faculty in academic goivns sat to the right The foreign
delegates and guests were seated in the front row, and several hundred
Dutch physicians and their ladies had come to the meeting which ivas
opened by the Rector of the university. Professor P C Flu, who in warm
ivords ivelcomed the guests and stressed the significance of the day He
rv’as followed by the Minister of Education, His Excellency Slotemaker dc
Brume, who is a great orator and knows it

Dr D Schoute then delivered the principal address commemorating
Boerhaave and his work* The tenor of his talk was a polemic against
Daremberg and a discussion of the facts that had made Boerhaave a truly

2A11 addresses veie published in Uie ftederlandieh Ti}dsehTi]t voor Ceneeshunde
4912 1938 A mimeographed Engluh iransbtion of Dr Schoute s address v,-as presenter
the English speatlng delegates and copies were sent to the chief medical libraries of *
United States.

A BOERHAAVE PILGRIMAGE IN HOLLAND 395

great man. When the master died, he was universally praised and no
superlative seemed strong enough to describe him. Charles Daremberg,
in his Histoire des Sciences Mddicales, felt rather helpless when he came
to a discussion of Boerhaave.* He found that the Aphorisms and the /n-
slitutiones possess neither profundity nor anything that surpasses ordi-
nary' human understanding, that they are neither novel in form nor sub-
lime or unheard of in the doctrine they present. He stated that Boerhaave
must have osvned his fame for the simplicity of his life, his disinterested-
ness. his high qualities, strong sense of duty, enormous historical knowl-
edge, and to the elegance and lucidity of his teaching. Dr. Schoute
pointed out that this picture was completely erroneous and that Boer-
haave’s significance to be sought first of all in the fact that he put
medical education on an entirely new basis. A passionate teacher all his
life, dex’oting every effort and every minute he could spare to his stu-
dents, he laid the foundation for modem medical education.

It rvas then the turn of the foreign delegates. Professor Dicpgen traced
the very strong influence that Boerhaave exerted on German medicine.
As late as 1770 Frederick the Great, commenting on a report of the
Superintendent of the Prussian universities, tvrote: “In medicine the
professors must adhere first of all to the methods of Boerhaave,’* and a
century after Boerhaave's death Ludwig I of Ba\'aria had his bust placed
in the Valhalla near Regensburg as the bust of a “great German man."

Professor Comrie pictured the foundation of the medical school of the
University of Edinburgh by a group of men who all had been students of
Boerhaave. But he showed that the relations between Edinburgh and
Leiden were not unilateral and that a Scotch physician, Pitcaime, was
Professor at Leiden and had some influence on Boerhaave.

My turn had come. I conveyed the greetings of the American Associa-
tion of the History of Medicine, which had commemorated Boerhaave at
its annual meeting in Atlantic City on May 2, and I discussed Boerhaave’s
influence upon American medicine. The number of American students
who studied at Leiden in Boerhaave’s days svas not laige, and the chief
influence ^vas indirect, through Edinburgh. Most of the men ivho organ-
i 2 ed the medical department of the College of Philadelphia and consti-
tuted its first faculty were graduates of Edinburgh and had studied medi-
cine under professors rvho were students of Boerhaave. It was chiefly in
this way that the tradition of the school of Leiden was transplanted to
America, and that Boerhaave’s medical views dominated American medi-

* Histoire det Sciences Medicates, vol. H, Paris, 1870, pp, 889-890,

196

ON THE HISTORY OF MEDICINE

cine until they were superseded in the last quarter of the eighteenth cen*
tury by the theories of Cullen and Brown, which enjoyed a short but
wide popularity.

The next speaker was Professor Wenckebach who spoke on Boerhaave
and the Viennese school. In the middle of the eighteenth century medical
conditions were extremely unsatisfactory in Austria, and when Maria
Theresa ascended the throne in 1740 she soon recognized that a thorough
reform of the University of Vienna was essential if it was to remain a
pniversity in any sense of the word. Five years later she called a student
of Boerhaave, Gerhard van Swieten, who reorganized not only the urn*
versity but medical conditions at large. He in turn called one of his fel-
low students, Anton de Haen, to the chair of clinical medicine in Vienna,
and it was de Haen who initiated the tradition that made Vienna famous
as a clinical center throughout the world. It was a great pleasure to hear
professor Wenckebach discuss these developments, who is Dutch himself
and who until his retirement a few years ago was Professor of Clinical
Medicine in Vienna, thus holding the chair of de Haen.

The last speaker was Professor Dinger, who had come from Batavia and
paid his tribute to Boerhaave in the name of Greater Holland. After the
exercises, we all went to the monument of Boerhaave that faces the
entrance of the hospital and tvreaths were deposited in memory of the
master. This reminded me of another tvreath that sve had deposited in
front of the same monument in 1927 when the International Congress of
the History of Medicine was held in Leiden. Dr. Welch then was the
speaker.

After a luncheon tendered by the medical faculty, we assembled in the
hospital garden for one more formal exercise. The students of the medi-
cal school wanted to pay their tribute to Boerhaave’s memory also. They
collected funds among themselves to erect a clock in the tower of the
medical school building. A student dcl^ate spoke. Dr. Maas, Superin-
tendent of the hospital, answered and in the name of the hospital and
medical school accepted the clock, which then was unveiled. It was a
joy to see the young students, boys and girls, in the beautiful surround-
ings of the Boerhaave-Kwartier, and it reminded you of the fact that the
medical school of Leiden not only has a great past but is a great media
center still, worthy of its glorious traditions.

And then the pilgrimage began. It was to bring us to all the pisca
where Boerhaave had lived, which was easy to achieve as he had never
left his country. He was in touch with the whole world. Seeds were sent

A BOERHAAVE PJLGRIMAGE IN HOLLAND

197

him for the botanical garden from far remote regions, and he had a tre-
mendous correspondence trith many people who sought his medical ad-
vicc, but it seems that the only journey he ever undertook was the trip to
Hardenvijk where he went for his medical degree. We first visited the St.
Picterskerk, a fourteenth century Goliiic church in which Boerhaave is
buried. His monument is an um-shaped tombstone with figurines in
relief representing the ages of man. The inscription reads “Salutifero
Boerhaavii Genio Sacrum.” Other famous Leiden scientists arc buried in
this church, sucli as Dodonieus, Clusius, and Camper.

Our next visit was to the rooms in which Boerhaave gave his clinical
teaching. They were two wards of six beds each, one for men, one for
women, in llie St. Caecilia Gasthuis. The building now contains work-
shops for unemployed, and Boerhaave’s ward serves as dining room.
Plans have been made for restoring the building and making it a
museum. It was in thU room that generations of physicians were trained
in clinical medicine.

In buses wc drove to Boerhaave’s birthplace, the parson's house in
Voorhout. Boerhaave was bom here on December 31, 1CC8. His father
tvas minister of the church in that village, an educated man who liad “a
good act^uaintance with the Hebrew as well as Greek and Latin lan-
guages, but excelled in his knowledge of history; and was no less remark-
able for frankness and candour in general, than for the prudence of his
Oeconomy, and a tender exemplary behaviour to his numerous off-
spring.”^ And numerous it was. Boerhaave had six sisters, and after his
mother's death, when he was five years old, his father married again and
had six more children. It was in this house that Boerhaave received his
first education. His father intended him for the ministry also, and with
this view “he himself initiated him in grammar, according to the method
of Vossius, and proceeded with him from the Colloquies of Erasmus to
Terence, die Greek cestamenc, and universal history’, particularly C/fns>
tiani Matthiae Theatrum; and with such success, that at eleven our youth
svas well versed in these, expert in the rules of the Latin and Greek gram-
mar, ready at translating and svriting Latin, and not ignorant of etymo-
logical learning.”® His hours of leisure were devoted to horticulture, and
it was in his father’s garden that he first became a lover of the scientia
amabilist botany. A long illness interrupted his studies. It was in his o^vn

4 ''Commeniariolus De Familia, Sradtfs, Wue Cursu. etc. Propria Boerhaavii ifanu
ConscriptuJ. Et port Obitum inter EJuidein MSS. Repemu," in tV- Burton, op. til., p. 203, S.

tJbid., p. 204, 4.

198 ON THE HISTORY OF MEDICINE

thought o£ studying medicine At the ^8= university as a stu

school in Leiden, and two years later he entered the un y^^
dent ot philosophy and theology His lather ^ic ^s^left ,n a difi

child, was not yet sixteen years ot age. and the family was left

cult financial situation Poeleecst, m

Our next station was Boerhaave’s country
Oegstgeest near Leiden The ‘ ° country

come a world tamed wealthy physician Patienu from '
came to Holland to seek his advice ' From ten till tw
room was thronged by those who sought his advice, to p
now made it impossible for him to visit pa>n;nts >n
enough the morning consultations outlasted the fixed h .
ture iime had come before he had had a moment in whmh to
dinner At three in the afternoon, additional patients ^ ‘

What remained ot his day was spent in an extensive corre p
m his longcontinued labors upon the writings of the Greek p y ,
unless some distinguished patient dragged him away from
No wonder that wealth Bowed to him from all parts, n ^
posed that his only daughter would inherit a few toils ^ ,ccep

purchased the beautiful country house that we visited ' ,^y,ll,nk
tion was tendered to us by the present owner, Mejonkv .
van Bennebroek The house is uufumislied at present an uilh s

pair but IS still a grand mansion, surrounded by aii old p
pond in front, and with a beautiful view of the flat Ian j^^iOLCC

Leiden In addition to this country house Boerhaave ' ,,, flo*

on the Rapenburg which we passed repeatedly, without vi

The day ended with a banquet in Leiden, in the Huize jpend

famous for its excellent cuisine, and it was a very great P work

a tew hours with our Dutch friends who are doing ^c P of the
in medical history J G De Lint, who organized seven'

History of Medicine and Science at the University of Lei ^ ’ Instorisa
years ago and was succeeded by F W T Hunger, the em ^

SAlbrecht Haller Tagtbuditr inner Beiien noeli '’'““'‘'“"'‘r ” ag"l883 PP ””
1723 1727> nHl Ammeikungen herausgegeben von Ludwjg Hinc

TIb«d,p 38

A BOERHAAVE PILGRIMAGE IN HOLLAND 199

of botany. B. "SV, TJi. Nuyens is still \’ery active and enterprising, and
the Dutdi Society of (he History of ^fcdicine, Science, and Mathematics
has a svidc appeal in the country, meets regularly, and publishes its trans-
actions %vith the Nederlandjch Tijdschrift voor Geneeskunde. The his-
tory of science has another center of research in Holland in the Neder-
landsch Historisdi Natuunvetcnscliappelijk Museum, in Leiden, an
outstanding museum of the history of science svith a staff of researchers
u'ho are approaching the subject from a broad philosophical angle. Dr.
C. A. Crommclin is Director of ilie museum, Prof. C. J. v. d. Klaauw,
Adjunct Director, and Dr. M, Rooseboom, Research Assistant.

The follou’ing day, September 24, sve met in Utrecht, from where we
dros’e to Hardenvijk, a small town of about 9000 inhabitants in the
province of Gueldcrland, located on what used to be the Zuider Zee and
now Yssel Lake. Here on July 13, 1693, Doerhaave obtained his degree
of doctor of medicine. The origins of the Academy of Hardersvijk can be
traced far back to the fourteenth century. In 1372 a grammar school was
established in the monastery of Uie Franciscan friars. It must have been
very popular during the Renaissance, because in 1503, when a great fire
destroyed the city and also the school, not fewer than 350 pupils lost
their lives. The school survived the catastrophe, Iiowever, and remained
the center of higher education in the province until it ivas replaced by the
Provincial Guelder Academy in 1648, which lived with ups and downs
until it was closed in 1811.

"We assembled in the town ball and were welcomed by the mayor, a
jovial gentleman svho gave us some information about the history of the
city and, later, showed us the very interesting municipal museum. A local
physician. Dr. C. P. J. Penning, then read a paper commemorating Boer-
haave at Hardencijk. On July 12, 1693, Boerhaave arrived in the city,
twenty-four years old, a Doctor of Philosophy of the University of Leiden
and a Bachelor of Medicine. He carried with him his thesis De Ulilitate
Explorandorum in Aegris Excrementorum ut Signorum, which he de-
fended the following day before the assembled faculty and student body
of the academy. He was examined about a case of apoplexy, about some
aphorisms of Hippocrates, and about the thesis itself. His answers must
have been satisfactory because the Album Studiosorum Academiae Gelro-
Zutphanicae, in which his examination svas entered, bears the mention
“Omnia exacte et soUde.” Dr. Penning speculated as to hosv Boerhaave
spent the night of his graduation day, whether in learned conversations
■with his professors or in drinking and feasting svith his fellow students.

200 ON THE HISTORY OF MEDICINE

It 15 well knotm that the Hardenvijk students ivete a rough gang In Di

Penning s^vords

rv ilh unllsgsmB teal the Aeadem.cal Senate fought agaimt the
nocutnal npSar^andalnn. the catching and eating of somebody ' “ ^lem “e
soealled graduating of hens fghting and drawing the rapiers but all was
asail Esen the prohibition of all the studenu clubs has neser been ' f
end to the life of the soealled Litde Senate of the students wilh lU seal ''P'“ *

tlic Goddess Pallas seated on a wme^ask encircled by the swords Sigill I
Senatus minons ®

We know from Haller s diary that student life in Leiden was somcishat
different

Leiden seems lo base been made on purpose roost convenient for studenu
utterly informal and )ou may walk in the suecu in your dressing gown wit o
irouble You do not mut with anybody but your own kind for the Dutch ®
and ihcir Viomenfolk rcsened v.ith the so-called Sludiosi a fact that
much money and many hours m the course of the year One student enwura^^^^
other s^ iih his example and he who does not work must expect a life of te ^

tedious idleness No kind of dissipation is made easy Wine and all luxon ^

pemise \nd finally the departments the profeuors real and Uie organW >
University are incomparable and if a roan docs not feel like getting a ea
certainly will not anysshcre else<

And ) et ishen the studenu had passed their exammations they let loo*^
m Leiden also-and they still do j n and

Boerhaase in all probability left the city the day after gradiiatio
there has been some discussion as to s\hy Boerhaasc made the
IlardcnMjk s>hy he did not prefer to take his degree from his
scTsit) Leiden The answer probably is that graduation at Hjir
was clicipcr and for an impecunious student like Boerhaase t u
a great deal racad

From the tos\n hall s\c walked to the old building of the
emy It was located in a church Across the street svas the Hortus
ais with a tower that svas used as a career a jail for unruly p{
TckUj the tower is adorned avith the bust of another famous grat
the academy 1 innacus s> ho took his degree in 1735
a beautiful tablet in green hronre, ssith Bocrhaascs portrait
and an inscription in sshich the Dutch physicians pay tribute

master, was iinscilcd.so that nosv HaitlcnMjk s tsso greatest gra t ^

• t P J Pcnnln; *De Prtwnotlff tan llorthaaTt le I!jr«lcr"lA“ In

S*?S 1953

• 0/* nl- p Tt

A BOERHAAVE PILGRIMAGE IN HOLLAND

201

recorded on the same monumcnL Dr. C. Felimers, President of the Dutch
Medical Association, dedicated the tablet.

A lunclieon tvas then offered to us, a real Geldersche koffietafel, in a
garden restaurant on the shore of the Ysscl Lake, and after that we sailed
by boat from Hardertvijk to Amsterdam. U was a delightful trip of sev-
eral hours, and just at sunset we reached the city. This concluded our
pilgrimage— and two enchanting days.

BOERHAAVE’S influence
UPON

AMERICAN MEDICINE

V VhEN Boerhaave d.ed nvo hundred years
lost undisputed master Never before had a

such a far reaching influence Never before had a ° , r,p.„,

versally admired and beloved H.ppocrat« was an ,^.o,

Sydenham was a great practitioner, but ^ and rich

Europae praeceptor," and when he passed ,

life, his many students all over the western bemoaned him

What was the cause of Boerhaave s unparalleled p pjo-

career, nor his writings His career was that of a h.gh^
fessor and great practitioner, who was „untries But

whose advice was sought by prominent people f™™ "" J time

there were many other famous professors and „„,ers

Boerhaave s writings, good as they ate, cannot e p
fame either Eclectic in character, they contain the es
pcnence in concise form but are by no means ""olutiona^ r
Leal new discoveries or basically new thoughts The

probability would have progressed just m

Loks did not create Boerhaave s fame They b;“”^Xorl-

icprinted over and over again because they were Boerhaave s^ ___

The cause of the master s universal reputation is b
personality, in h.s fascinating ? ,'?‘"Lmlege to attend ho

Ln Whoever listened to him, whoever had ^ f, "r^ of the hosptta'
counes at the bedside of the patient in the two small war

203

BOERHAAVE AND AMERICAN MEDICINE

behind the VrouKcn-Kcrk, felt the magnetism of his personality and de-
veloped a fanatic devotion to him. We can catch the atmosphere that
surrounded Boerhaavc in the student diary of Haller, in his commentary
to the Imlilulioncs, and in \'an Swicten's commentary to the Aphorisms.
Written from lecture notes, both these commentaries frequently illustrate
the master in his own words and supplement what the conciseness of the
original text concealed. Bocrhaave knew how to inspire young people. He
gave them no dogmas but a scientific method of approach to medical
problems. And when the students left Leiden they spread all over the
western world and passed the master's teaching on to their o\m students.

Every period has a definite medical ideal, and history has stamped
those men as great doctors who came nearest to the medical ideal of their
time. Bocrhaave is one of them.

Coerhaave's influence on the Viennese school, on Gottingen and Edin-
burgh, is well knovm. But this influence reached further, to Turkey in
the East and in the West to the netv world— to America.

There was no medical school in the English colonies of North America
until the medical department of the College of Philadelphia was or-
ganized in 1765. There were few doctors in the colonies, and a young
man who desired to become a phpician had the choice either to learn the
art of medicine by serving a practitioner as an apprentice for a number
of yean— usually six-or then to go abroad for study at some European
univenity. Traveling, however, was expensive, the colonies were not rich,
and few people could afford to spend years of study abroad.

It has been estimated that c^-cn at the time of the Revolution the colo-
nies had not more than 3500 physicians, of whom only 400 had a medical
degree. The others had all been trained through apprenticeship, a system
which, primitive as it may seem, had definite advantages. It provided
thorough practical instruction at the bedside of patients at a time when
many European universities were still emphasizing the theory of medi-
cine. And in addition it trained the student in both medicine and sur-
gery, while in most European countries there still existed a definite an-
tagonism between the two fields. Not a few students, after four years of
liberal education in college and six years of medical apprenticeship, com-
pleted their course of study by traveling in Europe for one or more years,
a trip that svas the more profitable as the student already had a good deal
of practical experience. The medical schools organized in America in the
eighteenth century (after Philadelphia: the medical department of King’s
College in New York, 1768; Harvard, 1783; Dartmouth, 1798) were not

204

ON THE HISTORY OF MEDICINE

meant to replace the apprenticeship system hut to supplement it, so as to
combine scientific with practical instruction.

Those American students who went abroad were naturally inclined to
study in their country o£ origin, in England or Scotland In 1726 the
medical faculty of the University of Edinburgh was founded, and
throughout the eighteenth century American students went to this um
^ersity m increasing numbers

* Other students studied in continental universities, particularly in
France And some went to Leiden and became students of Boerhaave
Their number is not large '

Lewis Johnston was matriculated at Leiden m 1 729 and was graduated
from Rheims m 1 732 He was a New Yorker who later practiced in Savan
nah, Ga where he became a member of the King’s Council
William Bull was born m South Carolina in 1710 He took his doctors
degree at Leiden in 1734 with a dissertation, De CoUca Pictonum He
probably was the first American graduate of the University of Leiden
Back m his home country he did not practice medicine but took an active
part m political life, became Lieutenant Governor of South Carolina
was an ardent royalist m the Revolution, and left for England m 17S2
John van Beuren, descendant of a Dutch New Amsterdam family, must
have studied at Leiden at about the same time as Bull He became a
distinguished physician in New York, where he practiced over thirty
years In 1736 the city of New York opened a ‘ Pubhck Workhouse and
House of Correction,” a combination of poorhouse and pnson An m
firmary for the sick inmates was attached to it— the origin of Bellevue
Hospital— and van Beuren was appointed physician m charge *

Isaac Dubois was another New Yorker who studied under Boerhaave
and was graduated after the masters death in 1740 with a dissertation
De Sanguwis Mtssianis Usu el Abusu He practiced m New York and
died from yellow fever a few years after his return

Samuel Nicholson, a Marylander, was matnculated at Leiden in 173
He never returned to America but practiced at Stockton-on Tees

Two Philadelphians, Phineas Bond and John Redman, studied medi
cine at Leiden after Boerhaave’s death. Bond in 1742, Redman m 17
and 1748 when he was graduated with a thesis, ,

The immediate American students of Boerhaave could not exert muc

1 They are listed in Innes Smith E»gl$sh SpfaAmg Students of Mediant ot the Untvernty
o\ Leyden uith foreword by John D Comrie Edinburgh and London 1932
ajamwj Walsh r/ufor)i o/Med/eine in hrawyorfc,Ncw YorV 1919 vol 1 p 20

BOERHAAVE AND AMERICAN MEDICINE

205

influence in their country. Nicholson, as we saw before, remained in
Europe. Bull abandoned medicine. Dubois died very young, and only
Johnston and van Beuren practiced for a longer period of years. Boer-
haave's influence upon American medicine, as a matter of fact, was
largely indirect, and the chief centers of influence were the University
of Edinburgh and the College of Philadelphia.

The medical faculty of the University of Edinburgh® can truly be
called a daughter of Leiden. Most of the first professors appointed were
students of Boerhaave; James Cratvford (physic and chemistry), Alex-
ander Monro (anatomy and surgery), Andrew Plummer (chemistry and
medicine), Charles Alston (botany). The oflScial textbooks used in the
courses tvere Boerhaave’s books. Andrew St. Clair taught institutes by
discussing the Inslilutiones Medtcae; John Rutherford used the Aphor-
ismi de Cognoscendis et Curandts Aforbis in teaching the practice of
medicine. The Elementa Chemtae served as a textbook in chemistry
courses. The method and spirit of Boerhaave permeated the school and
were kept alive long after the master’s death.

We mentioned before that, totvard the middle of the eighteenth cen-
tury, American students came to Edinburgh to study medicine in ever-
increasing numbers. In Edinburgh tJjcy were taught the principles of
Boerhaave’s medicine. They went home to America with Boerhaave’s
books, applied his principles in their practice, and passed them on to
their apprentices. No wonder that Boerhaave’s medical system dominated
in American medicine for decades.

Dr. Benjamin Rush of Philadelphia, whom we shall discuss presently,
wrote in the matter:*

The system of Dr. Boerhaave then (1760) governed the practice of every physician
in Philadelphia. Of course diseases were ascribed to morbid acrimonies, and other
matters in the blood, and the practice of those years was influenced by a belief in
them. Medicines were prescribed to thin, and to incrassate the blood, and diet drinks
were administered in large quantities, in order to alter its qualities. Great reliance
was placed upon the powen of nature, and cn'ucal days were expected with solicitude,
in order to observe the dischafge of the morbid cause of fes’ers from the system. This
matter was looked for chiefly in the urine, and glasses to retain it were a necessary
pan of the furniture of every sickroom. To ensure the discharge of the supposed
morbid matter of fevers through the pores, patients were confined to their beds, and
fresh and even cool air, often excluded by closed doors and curtains. The medicines to
a John D. Connie, History of Scottish Medidae, London, 1932, vol. I, p. 289 H.

< Benjamin Rush, "An Inquiry into the Comparative State of ^^edidDe, in Philadelphia,
between the years 1760 and 1766 and the year 1809." in B. Rush. Medical Inquiries and
Observations, ed. 3. Philadelphia, 1809, voL IV, pp. 39S-M6.

206 ON THE HISTORY OF MEDICINE

promote sweats were generally o£ a {eenle nature The spintus mtnderen and the
spirit of sweet nitre were in daily use for that purpose In dangerous cases saffron and
Virginia snake root were added to them

In the year 1765 the medical department of the College of Philadelphia
was organized It was the first medical school in the English colonies of
America It was founded upon the suggestion of Dr John Morgan who
had taken his degree at Edinburgh in 1763 after having studied for six
years with Dr John Redman who was a graduate of Leiden Thus he
had been exposed to the tradition of Leiden from two different sides

Morgan s ambition was to create in Philadelphia an institution similar
to the medical school of Edinburgh In his famous Discourse upon the
Institution of Medical Schools m America, he says ®

Of what consequence the united eQorta ol men learned in their profession ate ihe
medical colleges of Edinburgh afford a remarkable instance Within the space of
little more than forty years the present professorships m Medicine were first formed
A few gentlemen from Scotland then prosecuting their medical studies at Leyden
concerted a plan and undertook themselves the important charge of instituting
schools for teaching the various branches of Medicine They met with countenance
and support from the patrons of the umvers ty and by the great abilities assiduity
and experience of those gentlemen and some few of their successors the reputation
of that place is railed to such a height that to their immortal honour it already
rivals if not surpasses that of every other school of Physic in Europe The names of
Drummond Dick Clerk Rutherford Sinclair Alston Plummer Monroe \Vhyit
Cullen Hope Black and some others ate now known wherever the knowledge of
Physic IS cultivated and they are revered at home as parents and guardians of the
healing arts There « a great resort of medical students at the university of Ed n
burgh as well from Great Britain Ireland and the West Indies as from the Con
tments of Europe and America These brjng to the university and city considerable
advantages and in return carry the fame of their learning and their professors to
every quarter of the globe Were it necessary 1 could easily enumerate many similar
instances of the improvement of science but these I imagine will suffice for the
present

Why should we be deterred from establishing like institutions of Medicine in this
seminary especially as so many arcumstances conspire to invite and encourage so
important an undertaking

Morgan stressed the necessity of theoretical studies for the practitioner
and referred to Boerhaave as an example ®

The great Boerhaave whose example is worthy of imitation laid it down to In®-
self as an inviolable law to divide bu time between study and practice

B Philadelphia 1765 pp 28 30

cop cil p is

BOERHAAVE AND AMERICAN MEDICINE

207

Morgan succeeded with his plans without difficulties, because the idea
was in the air. The need for a medical school was generally felt in Amer-
ica, and Philadelphia ^vas an excellent place for such a foundation. It
had a flourishing college that rvas soon to become the University of
Pennsylvania, and it had a very good hospital, the Pennsylvania Hospi-
tal, that had been founded in 1751.

The new medical school had an excellent faculty consisting largely of
graduates of Edinburgh. Morgan himself was appointed Professor of the
Theory and Practice of Medicine. William Shippen, another Edinburgh
graduate, was made Professor of Anatomy and Surgery (1761). Thomas
Bond gave clinical lectures at the hospital. He %vas a brother of Phineas
Bond, who had graduated at Leiden, and was himself a great admirer of
Boerhaave, whom he quoted in a clinical lecture held in 1766:^

The great Boerhaave was no: only present at human post-mortems, but attended
Leiden Slaughter Houses. When asked, how he knew so much about diagnosis and
prognosis of disease he replied; (1) examining dead bodies, (2) studying Sydenham's
Obseniationes and Bonetus* Seputchretum Amtomicum, both of which he had read
10 times.

In 1768 Adam Kuhn, a brilliant student of Linnaeus, and also a gradu-
ate of Edinburgh (1767), was appointed Professor of Materia Medica, and
in 1769 Benjamin Rush joined the faculty as Professor of Chemistry. Like
Morgan he had studied with John Redman for six years and had grad-
uated at Edinburgh (1768). After Morgans death in 1789, he succeeded
him as Professor of the Theory and Practice of Medicine.

It was the youthful faculty of a young school. If the faculty of Edin-
burgh could be called a daughter of Leiden, then the faculty of Phila-
delphia can with equal right be called a daughter of Edinburgh and
therefore, a granddaughter of Leiden. No wonder that the spirit of the
new clinical medicine was fully alive and that Boerhaave’s influence
was strongly felt.

It was felt also outside of Philadelphia. Edinburgh graduates had in-
fluential positions in other cities. Samuel Bard, a graduate of 1765, was
the first Professor of the Theory and Practice of Medicine in the medical
school of King’s College in Nesv York, which had been organized in
1768. It was discontinued during the revolutionary war, was revived, was
amalgamated with the College of Physicians and Surgeons and ultimately
became part of Columbia University.

7 Published by Frauds R. Packard, History of Medtexne in the United Stales, New York,
I93I.vol.II.p. 1201.

208 ON THE HISTORY OF MEDICINE

In the seventeenth and early etghteenth *5

Nosoloiy was published in 1769. his First Lines on the Practice of y
from me to 1784. and John Brown’s Browns

1780 Benjamin Rush was largely responsible £or the 'P"® ^

Ideas He was a very lorcetul teacher, and his opinions carried mucn

weight Although he claimed to have a system o£ his orvn. yet It was^^

mg but modiBed Brownian theory In the pamphlet quoted
pictures the development as follows *

I proceed m the order that vias proposed to tale
op, mom which prevail among the physicians ot ’^‘"'“'’''1’’’'“ ^ succeeded by the
haave long ago ceased to regulate the practice of p yn introduced

system of Dr Cullen In the year 1790 “f but it soon

and taught by Dr Gibbon It captivated a I”""? „|ed the fallaq

tell into disrepute Perhaps the hightoned diseases of ou I P u his

and danger of the remedies incalcuted by it and aSorded it a „u,ry promiil

Ld m Lny other countries In the year 1790 the auUior .h,

gated some new principles in medicine suggested by the pecu p ,, j„d

diseases ol the United State, These principles have » ,11 di.

improved by the successive observations and remonings ol O'’ I S juiogical of

states as to fonn a new system of medictne This system '
disease, and admit, only ol a single disease consisting m didere
excitements induced by itritanu acting upon previous ‘ieb.lity I
undue reliance upon the powers of nature and teases *““"1 options lol

alt violent and feeble disease, out ol her hands and lasdy It J P £u„,„g and
the name, ol diseases and by dimcting their “PP''“''°" which ba«'

Buctuating state, derive, from a lew active medicines ‘he d European treatise,
been in vain expected from the numerous articles which compose P

upon the materia mcdica , , nf Philadelphia but a

This system has been adopted by a part of the physicians
respectable number of them arc still atuched to the system o

In the begtnnmg o£ the nineteenth century Parts o£ a

attmetton fur Amencan phystcans and th.s marks the beginning
new period m the history of American medicine " ^

SB Rush "An Inquiry into the Comparative State ot ^'m'/aail <>*

tween the yeam 1-60 and 1768 and the year 1809 in B Ruih Jl.dim, »7
„„ulm« ed ! Philadelphia 1809 vol IV pp 409 410 ^ dW

» I Wish to thank ^^lss Genevieve Miller for the help she has gi
material for this paper

AN ELIZABETHAN POET’S
CONTRIBUTION
TO PUBLIC HEALTH:

SIR JOHN HARINGTON AND
THE WATER CLOSET

M EDICAL history remembers Sir John Harington (1561-1612)
for two contributions, his English translation of the Regimen Sanitalis
Salemitanum and—more important-~hi$ invention of the trater closet.

Harington’s life has been presented very delightfully by George Adami
in a paper that was read before the Johns Hopkins Hospital Historical
Club in 1908.' We shall not repeat the biography but merely remind the
reader that Sir John Harington svas a man of the world, godson of
Queen Elizabeth, courtier and poet who translated Ariosto’s Orlando
Furioso. Educated at Eton and Cambridge, he studied law at Lincoln's
Inn, tvrote epigrams, accompanied the Earl of Essex on his expedition to
Ireland, lived at the court when he svas in favor, on his estate at Kelston
when he ivas in disgrace. More than once he infuriated the Queen with
his pranks, but he ahvays succeeded in being pardoned.

Harington's The Englishmans Doctor. Or, The Schoole of Salerne. Or,
Physicall observations for the perfect Preserving of the body of Man in
continuall health, published in 1607* and several times thereafter, svas

in was published first in the SulUtin of the Johns Hopkins Hospital i?:285-295, 1908.
See also Bishop Mandell Creighton's article in Dictionary of National Biography, 1908, sol.
VIII, pp. 1269-1272; Lytton Strachey’s essay in Portraits in Miniature, London. 1931, pp.
1-9; Townsend Rich, Harington and ^nosto. New Haven, 1940.

s Reprinted New York, 1920, Paul B. Hoeber. with Latin text and introductory essays
by Francis R. Packard and Fielding H. Ganison.

210 ON THE HISTORY OF MEDICINE

the first EngUsh translatton of

‘'■vr:arc7osi«^«“

tame m the Rabelatsian Pf °Xd Ihl MelamorphoM of
mle ^ Nete D, scours, of a Stale f

^.atc Wnlten by Misacmos to namphlets, also anonymous

It was followed the same year y s ? Anaiomte of

on the same subject, the most notable o method ts ftaniy-

the Metamorpho sed Aiax Wherein by f cliquidated, by

openly, and demonstratiuely. declared, J„,, „oyscm

pen, plot Ir precept, hou, vnsauerie places may /„ ,He

liases made mholesome, filthy places made ^yTC’

common benefite of builders, house “P'”’ Uusicke, professor of
Traueller Apprentice in Poetre, „ artes and

Painting, the mother, daughter, and handmayd of all Muses

sciences • , . i . ij,r,n»inn s fictitious couim

Ajax IS a pnn, standing for a jahes H g pictures

Philostilpnos had heard much of the wonders of his house, P
walks ponds swimming place andboau

But to deale pUmly with you where he three ipeaaH , lauding

much hoalled oI and therelore would wininglyest J e die second >

„„ pillen like that in Ariosto vnder which you WJ I he.re ,0«

shoMins close with a XU score marke to euer, P”'"' ,„d [„.t£ull with »
haue hit a mark that many shoot at eil to make a b J reueience k >'

little cost the third is a thing that I cannot name w 1 * ^ pl,a

,t sound, not vnl.ke the shooting place ■>»> « ” ” P'’I ® ,0 .1 to vse ss»'

Though It be so sweet and so cleanely as I ,h,„le ducorW'

reuerence lor one told me it ts a, sweet as "y (a. you par^J

one should say saue reuerence my parlor But il I mg „„ing

promist me at your last being here) to set d™" „an M

plaine as our grosse wins here may end^taud it or to M „„„ mw

(who 1 vnderstand can paynt pret.ly) make a dtaug P „ f, perhaps y

ceaued you should make many ol your Inends much behold g th.nke »

might cause relotmation in mame houses that you wis seriouslye i T

Zne to lollowe your good example Nay to tell you my opinion

SThomasCombe Ilanngion s servant from the orig nal odi“°a .

SThe Meleeiorp/oii. and the Xnatoeiie .Zdncuo" by Jadi

1927 edited by Peter Warlock and Jadi tindiay wilh an mt.o
Son Fanlrohm Pro» O-r quo.at ons are Iron, this ed non

HARINGTON AND THE ^VATER CLOSET

haue so easie, so cheape, fc so infallible a way for auoyding such annoyances in great
bouses: you may not onely pleasure many great pcnons. but doc her ^ra^esty good
seniice in her Pallace of Greenwitch and other stately houses, that are oft annoyed
with such sauoures, as where many mouthes bee fed can hardly be auoided. Abo you
might bee a great benefactor to the Citie of London, and all other populous townes.
who stand in great necde of such conuayances. But all my feare is that your pen
hauing beene inured to so high dbcourse.

“Of Dames, o£ Knights, of armes, of loues delight."
will nowe dudaine to take so base a subjea.

Of vaults, of sinkcs, priuies Sc draughts to svrite.

But herein let a puhlick benefit expell a priuate bashfulnesse, t if you must now and
then breake the rules de slotiililafe montm, with some of these homely words, you sec
1 haue broken the ice to you, and you know the old saying, pens may blot, but they
cannof blush. And as olde Tarlton was wont fo saie, this same excellent worrfe saue-
rcucrence, makes it all manerlie. Once ihys I dare assure you, if you can but tell a
homely tale of this in prose as cleanly, as you haue lolde in verse a baudie ule or
two In Orlando mannerlie, it maye passe among the sosvrest censurers verie currantly.
And thus expecting your answere hereto, at your conuenicnt Jeysurc, I conunit you to
Godthis of 1596.«

Misacmos (Harington) could not resist the invitation;

Now Syr, to come to the chiefe point of your desire, which requires a more ample
answer, but for a preamble you must be content with this. You tell me, belike to
encourage me, that my Inuention may be beneficiall, not only to my priuate friend,
but to Townes and Cities, yea euen to her Maiesties scruicc for some of her houses:
trust mee 1 doc beleeue you write seriously as you teanae it beerein, and for my pane
1 am so wholly addicted, to her highnesse seruice, as 1 would be glad, yea euen
proud, if the highest stniine of my wine, could but reach to any note of true har-
mony in the full consort of her Maiesties scruicc, though it were in the basest key
that it could be tuned to. And if 1 should fortiine to cHect so good a reformation.
In the Pallace of Richmond, or Greenwich (to which Pallace. many of vs owe scruicc
for the tenure of our lande) I doubt not but some pleasant wilted Courtier of
either sex, would grace me so much at least: as to say that 1 were wrihy for roy
rare inuention. to be made one of the Priuic. (and after a good long parenthesis,)
come out with chamber, or of they bee learned and haue readc C«uta/ioi Couriier
they will say, 1 am a proper scholer, and well scene in latrina fingva. But let him
mocke that list, gui moecat moccabilur.*

The "stale subject” is discussed in endless variations with a great dis-
play of classical learning, and finally in tbc third section Harington
comes to the description of his inwnfion:

• Ibid^pp. I-S.

e7t>,-<f,pp. e-7.

212

ON THE HISTORY OF MEDICINE

Now therefore to come where we left tat, tor I knowe yoo woolde la.ne toe
your euitruettom ere you goe home, ut soone oj I haue giuen my horse *<>■”' «
vp this hill I will ride along with you, so you will ride a sober pace or
to ride with these goose chasing youthes. that post still to f"

when they come thither, they cannot remember what businesse they hau
that they had euen as muche m the place they came from

These inconueniences beeing so great, fc the greater because so genera ,
be a way with little cost, with much deanlinesse, with great felicitie. an P

ure to auoide them, were it not rather a sin to conceale it then a s °

Wherefore shame to them that shame thinke, for I will confesse ^ .Jjpj

both howe much I was troubled with the annoyance, and what I haue to
the remedies For when I found not onely in mine owne poore confused co g
euen m the goodliest 8: statlicst palaces of this realroe, notwithstanding
prouisions of vaults of sluces, of grates, of paines of poore folkes m ® i

scouring, yet still this same whorsom sawcie stinke, though he were c
on pam of death not to come witliin the gates, yet would spite of our no
when we wold gladliest haue spared his company, prease to the faire * jo
bers I began to conceiue such a malice against al the race of ^

oers i oegan lo conceiue sucii a luaiitc agauwi a. . r , „f {hem W

be at deadly fewd with them, till I had brought some of the ch^‘®” ®
vtter confusion And centering some principles of Philosophy I jnd

conueiances of architeciur I had seen, with some deuices of others I a ’
some practises of mine owne I had payed for, 1 founde out at last .pea^e

IS after described and a maniellous easie and chcape waye it is, an
It vpon ray aedite, not without good experience that though it bee ney
fetched not deare bought, yet it is good for Ladies, and there be few
may not haue the benefiie of it For there bee fewe greate and well con i _
but haue vaults and seaei passages made vnder ground, to conuey a'^T
ordure and other noisome thinges, as also the raine water that * ” ,

courtes, which being cleanly m respecte of the eye, yet because houses of

haue many vents, they are oft noisome m regarde of the smell Specia y » ^ ^

odice. that slande htghe from the ground, the tuns of them drawing vp i ^,nde

chimney doth smoke By which it comes to passe many times (specia y i _
stand at the mouth of the vaults) that what with fish svater coroming^^^
kitcliins, bloud & garbage of foule, washing of dishes and the with

other houses loincd together, and all these in moyste weather stirrc a
some small streame of rayne water, for as the prouerb is

Tis noted as the nature of a sinke,

Euer the more us stirde, the more to stinke ^

I say these thus meeting together, make such a quintessence of **^’”^'^use ih®

Paracelsus were aliue, his art could not deuise to extract a stronger o ^

most vnauoidable of al these things that keepe such a « (*

stinke when they be stirred, is vrinc and ordure, that which we al cary
good speculation to make si remember what we arc, and whither we
fore as I said before, many haue deuised remedies for this in onelf

niany yeares since, and 1 this last ycare, of all which I will ma e

HARINGTON AND THE IVATER CLOSET 213

two beside mine own to spealte off, became men of good judgment haue allowed
them for good, but yet (as the ape dooth his young ones) I thinke mine the properest
of them all.

The first and the ancientest, is to make a close rault in the ground, widest in the
bottome. and narrower vpward, and to floore the same with hot lyme and tarris, or
some such drie pauing as may keepe out all water and ayre also: for if it be so
close as no ayre can come in, it doth as it were smother the sauour. like to the
snuffes or extinguishers wherewith wee put out a candle, and this standes with good
reason, that seeing it is his nature to make the worse sauor the more he is stirred,
and nothing makes him keepe a more stinking stirre, then a little wjnde and water,
surely there can be little or no annoyance of him in this kinde of house, where he
shall lye so quietly. But against this is to bee obieaed, that if there be a little cran-
nie in the wall as big as a strawe, or if the grounde stand vpon winter springes or bee
subiect as most places vndcr ground are, to giue with moist weather, then at suche
times it must needs offend.

Besides in the Princes bouses where so many mouths be fed, a dose vault wd fil
quickly: and that objection did my Leadc of Leicester make to Sir John Young, at
his last being at Bristowe, who commended to my Lord that fashion, and shew'cd
him his owne of a worse fashion, and lofd him that at a friends house of bis at
Peter hill in London, there was a very sweet priuy of that making.

Another way, is either vpon close or open vaultes, so to place the seiges or seates
as behinde them may rise tuns of chimneys, to draw all the ill aires vpwards: of
which kind J may be bold to say. that our house of Lincolnes Inne, putteth downe
al that haue been made afore it, and is indeed both In reason and experience, a
meanes to auoid much of the annoiance that is wont to come of them, and keepeth
the place all about much the sweeter. But yet to speake tmely, this is not safe from
all infeaion or annoyance whyle one & there, as my sence hath tolde me, for

“Scnsus non fallituriu proprio obiecto.”

Or perhaps by the stricte wordes of the statute it ought to bee so, and that but tivo
partes may bee deuysed away, and a thinJe muste maaine to the beire, for I dare
vndenake, goe thither when you will, your next beyre at the common house, wbatso-
cuer charge hee is at in the sute, I am sure he may be made a sauor, at least for the
terliam partem aboue all reprises, if the bult be not his owne. And further when
the wether is not calme, the winde is so vnruly, that it will force the il ayres down
the chimneis. and not draw them vp, as we see it dooth in chimneyes where fire is
made, force downe the smoke, notwiihsunding that the very nature of fire helpeth
to enforce it vpwarde, where as these moyst vapoun are apt (euen of their owne
nature) to spreads abroade, & hang like a deaw about euery thing. Wheiforc though
I am but a punie of Lincolnes ynne and the builder hcereof was a bencher, yet
I will vnder reformation, preferre my deuise afore bis, eytber because it is better; or
else out of the common faulte of young men in this age, that wee thinke our deuises
wiser then our elders. Vet with this respective modestye, that because my deuise is
with water, where that cannot bee had, or where houses stand on an exceeding flat,
there I will leaue the worke to his oversight, but where any couenient current is,
and no want of water, there I woulde be surueyer, and so to deuide the regiment.

214 ON THE HISTORY OF MEDICINE

that .£ for the diye lat.de sendee hee bee ge«etall for the water tenttee I will be.
Admirall Yet I assure you this deuwe of none requires not a sea of water b
a cesterne not a whole Teams full but halfe a tunne full to keepe al ”

sauorie for I will vndertake from the pesants cottage to the princes palla
so much quautitie of water as is spent in drink in the house will
which if 11 were at Shaftsburie where water u dcerest of anie towne I
IS no great proportion And the deuise u so little eombersome “ « “ ^

pleasure then a pain a matter so sleight that it will seeme at the Best incredib
Le that you shal find it at al tunes infallible For it i

all the annoyances that can be imagined the sight the sauor the co
last to weake bodies is oft more hurtful then both the ot er w cr
stand ouer brooks or vaults daily cleansed with water And not to J
too long suspence the deuice is thys You shall make a false bottome to
that you are annoyed with either of lead or stone the which bottome s
a sluce of brasse to let out all the filth wluche if it be close plaistered a ^

& renced with water as oft as occasion serues but specially at noone an
will keepe your prime as sweete as your parlour and perhaps
and Quando be not kept out But my seruaunt Thomas (whose pensill ca P
more in thys matter then my penne) wyll set downe the forme of i ^

m the ende heereof that you may impart it to suche fnendes of yours y

think worthy of it though you put them not to so great penance as o
whole discourse ^

The subject is taken up again with technical details m An Anaiom
of the Metamorpho sed Atax * ^

Wherefore now seriously and in good sadnesse to instruct you ^ /they *5®
of worship how to reforme all vnsauene places of your houses 1 ke

caused by priuies or sinkes or such like (for the annoyance comming a
causes the remedies neede not be much vnlike ) this you shall do barrell or

In the Pnuie that annoyes you first cause a Cesterne containing a
vpward to be placed either behind the seat or in any place either in
or aboue it from whence the water may by a small pype of leade o a^ to

conuayed vndcr the seate m the hinder part thereof (but quite out °
which pype you must haue a Cocke or a washer to yeeld water wi *
strength when you would let it in j^p j]

Next make a vesscll of an ouall forme as broad at the bottome as a
foote deep one foote broad xvi inches long place this very close to
like the pot of a close stoole let the ouall incline to the right hand j

This vessell may be hreck stone or leade but whatsoever it is it s o stanil)
Current of S inches to the backe part of it (where a sluce of w

the bottome and sides all smooth and drest with pitch rosin and wax
keepe it from taynting with the vnne . . j vnu must fast«“

In the lowest part of this vessell which will be on the right han y

7 Ibtd pp 85 89 94 95
Hbtd pp ns 114

HARINGTON AND THE WATER CLOSET 215

tl'® slucc or washer of brasse with sodcr or Cioient, the Concauitie or hollow thereof,
must be ij. inches and Vi.

To the washers stopple, must be a stemme of yron as bigge as a curten rod,
strong and euen and perpendicular; with a strong skrew at the top of it, to which
you must haue a hollow key with a wootme fit to that skrew.

This skrew must, when the sluce is downe, appeare through the planke not aboue
a straw-breadth on the right hand, and being duly placed, it will stand three or
foure inches wyde of the midst of the bade of your seate.

Item, that children & busie folke, disorder it not, or open the sluce, with putting
in their hands, without a key, you should haue a little button, or sallop shell, to
bind ft down with a vice pinne, so as without the key it will not be opened.

These things thus placed; all about your vessell and elsewhere, must be passing
close plastered with good lyne and hayre, that no ajre come vp from the vault,
but onely at your sluce, stfhich stands dose stopt, and euer it must be left, after it is
voyded, halfe a foote deepe in cleane svater.

If syater be plentie, the oftener it « vsed and opened, the sweeter; but if it be
scant, once a day is inough. for a neede, though tweniie persons should vse it.

If the water will not run to your Cesteme, you may with a force of twentie
shillings, and a pype of eighteen pence the yard, force it from the lowest part of
your house to the highest.

But now on the other side behold the Anatomie.

“A Plaine Plot of a Priuie in Perfection” follows, two drawings with
descriptions and an account of costs which shows that this perfect device
could be constructed for the trifling sum of one pound, ten shillings,
and eight pence. In another section of the book there is a picture shott-
ing the privy in use.

The publication of the Metamorphosis of Ajax got its author into trouble
once more, not because of its subject— our Renaissance ancestors were not
prudish in physiological matters— but because of a suspected reference to
Leicester. There sras even some talk of the Star Chamber, but the whole
affair was less serious than it seemed. The Queen finally laughed and
even had a privy k la Harington built in Richmond Palace— with a copy
of the book hanging from the wall, whereupon the poet could not resist
the temptation of writing an epigram;*

To the ladies of the Qucfriw Priuy-Chamber, at the making of their
perfumed priuy at Richmond,

The Booke hanged in chaines saith thus:

^The Letters end Epigrams of Sir John Harington . . edited by Noman Egbert
McClure, Philadelphia, 1950. p. 165.

216 ON THE HISTORY OF MEDICINE

Faire Dames if any tooke in scorne and spite
Me that Misacmos Muse in mirth did write
To satisfie the amne loe here in chames
For aye to hang my Master me ordames
Yet deeme the deed to him no derogation
But deign to this deuice new commendation
Sith here you see feele smell that his conueyance
Hath freed thisnoysome place from all annoyance
Now ludge you that the work mock enuie taunt
Whose aeruice in this place may make most vaunt
If vs or you to praise it were roost meet
You that made sowre or vs that make it sweet?

Thus the water closet began its triumphant course in “

But It was a slow course Only a few rich people to ow , j

example In France at the time of Louu XVI ‘h"'
glaue-thiswas the technical term-in the palace ^er
m the Tuileries nor in Saint Cloud where the cfwise f
supreme Various patents for improved models of water clo
sued toward the end of the eighteenth century particularly
in 1775 to Alexander Cummings a watchmaker in
Prosser a plumber in 1778 to Joseph Bramah of

cal inventions But we do not know whether any use ^ ® ' j, 5 (U

these patents and it was only in the nineteenth century tna
were actually built more frequently ,vondercd

Most literary historians who wrote about Harington
why so useful an invention that gives us so much rom or
ceptcd generally and immediately Jack Lindsay m his far as

ductory essay on Harington and the Metamorphosis, even w
to speculate what would have happened it for once ^ , and read
Itself receptive to an idea « Every alderman would have oug
the book In ten years England would have been sewered
have written tomes on the Cloacae of Rome Charles w people

needed to erect a gibbet at the gate of Woodstock ® pj^gpe ol

evading plague quarantine There would have been no
London no Great Fire etc etc niorc

Alas there ivere good reasons why mankind did not

lOCabanis Moeurs Inlimes du Fasti Pans n d p S85 Treatnf

11 Glenn Brovm Water closets A Htstoncol Mechanical and
York 1884

12 Op a» p xxvhlff

HARINGTON AND THE WATER CLOSET

217

receptive to Harington’s idea. His privy ivas an improvement, to be sure,
but was cumbersome enough. The tank had to be filled. The fecal matter
was flushed but into a vault, into the jakes which had to be emptied by
scavengers. The water closet could not come into more general use before
houses were supplied with running water and connected with sewers.
Harington's purpose was not the sanitation of England but was to keep
a certain room “sweet and savory.” In this he succeeded well enough, but
centuries had to elapse before medicine could demonstrate the necessity
of plenty of fresh rvater and of a quick removal of sesvage.

The water closet was an English invention, and from England it con-
quered the world, or at least a small, a very small, section of it. Its Eng-
lish origin is still reflected in various languages. In Germany it became the
Wasserklosetl, or colloquially abbreviated the Kh. France no longer
speaks of Ueux a Vanglaise but simply uses the English term, rvater closet,
which is usually shortened and is pronounced somewhat like /e valere. It
is most appropriate that our children colloquially call this convenience
“the john" since it was a John who gave it to us in its improved form—
Sir John Harington,

A LITERARY CONTROVERSY
OVER TEA IN

EIGHTEENTH CENTURY ENGLAND

-IL-^UROPE owes Its acquaintance with tea to the Dutch East India
Company The company was founded in 1602, and as early as 1610 it
brought the first tea leaves from Bantam to Holland Before that time, m
the sixteenth century, missionancs had brought samples of tea from
China together with other drugs, but the history of tea dnnking in Eu
rope begins with the activities of the Dutch East India Company
Somewhat later, m I6S8, tea was brought from China to Russia by a
diplomatic mission of the Tsarist court Holland supplied other western
European countries with tea The new drug was first knoivn m Pans m
1635 and was brought from Holland to England between 1650 and 1655
It IS obvious that the British East India Company did not miss the op
portunity of importing an article of consumption that promised to be
come popular Its first shipment of tea reached England in 1660
Thus England came to know the new drug relatively late, but m the
consumption of tea it soon caught up with other European countries an
surpassed them very rapidly A beverage that had such a delicate flavor
or rather such a wide scale of flavors, that ivas delightfully stimulatin?
ivithout being intoxicating, could not but have a ivxde appeal In
seventeenth century the price of tea was very high, so that its consump-
tion ivas limited to the propertied classes, but m the eighteenth
under the pressure of a growing demand imports were increased,

219

A LITERARY CONTROVERSY OVER TEA

dropped, and tea ^vas consumed by rich and poor. From 1717 to 1726
England imported annually about 700,000 pounds; from 1732 to 1742
annual imports into London increased to 1,200.000 pounds, and in 1755
duties were paid for almost four millions of pounds.*

Tltc consumption of tea had become such il)at physicians and moralists
svere alarmed. Among the latter. Jonas Hanway was one of the most
articulate who in 1757 exclaimed pathetically:^

Will ihc tons and ot ihU happy ble, this reputed abode of sense and

liberty, for ever submit to the bondage of so tyrannicel a custom as drinking lea?

Must the young and old, and middle aged, the sicMly and the strong, the poor
and rich, in n*iifw weather and told, in moist and dry, with one common consent,
employ so many precious hours, in so low a gratification as drinking teal

Are we to be bred up from generation to generafiDn to this s’ast expcnce?

Is not this a want whicfi nature does not make, and are not many unhappy, if it is
not regularly supplied? ire. ire.

One might multiply these questions, and their answers might at one view set
the matter in its true light, if we had wit and honesty enough to consult proper
counsellors, and to follow their advice. Men seem to have lost their stature, and
comllness: and women their beauty. I am not young, but methinVs there is not
quite so much beauty in (his land as there was. Your very chambermaids have lost
their bloom. I suppose by sipping tea. Even the agitations of the passions at cards
are not so great enemies to female diarms. What Shakespear ascribes to the conceal-
ment of love, is in this age more frequently occasioned by Uic use of lea.

"Like a worm *’ the bud.

It feeds on the damask cheeL”

Jonas Hanway (I7I2-I786)* tvas a merchant and philanthropist. Bom in
Portsmouth he was apprenticed to a merchant in Lisbon at the age of
seventeen, and in 1743 he entered into partnership with a merchant in
Sc. PecersbuTg^ tvA <7 ww engage? ier the Ctspean ende. The same year he
conducted a caravan to Persia, where be had all kinds of adventures. He
was caught in a rebellion and had his caravan looted; sailing back to
Russia on the Caspian Sea his boat was attacked by pirates: stricken with
fever he was quarantined on the island of Caraza. Finally, in 1745, he

r Jonas Hanway, A ]oumal of tight Days Joumry from Porlsmouth to Kingston upon
Thames etc., ed. 2. London. 1757. vol. 11. pp. 22-23. 1 do not vouch for the accuracy of the
figures, since Hanway’s statements arc often ralber superficial.

2 Ibid . pp. 36-37. . ,

* For the biography and bibliography see John Pugh. ItemarkabU Occurrences in the
Life of Jonas Hanway, Esq., London, 1737.

220

ON THE HISTORY OF MEDICINE

found himself back in St Pctenburg, where he learned that a relative
of his had died and had left him money, more than he could ever make
in the Caspian trade He decided to go home, was back in England in
1750, and did what one does in such a case he wrote a four volume book
about his travels which was published m 1753 under the somewhat
lengthy title An Hisioncal Account of the British Trade over the Coi
plan Sea, with the Author^s Joiimaf of Travels from England, through
Russia, into Persia, and hack through Russia, Germany, and Holland
To which are added, the Revolutions of Persia, during the present Cen-
tury, with the particular History of the great Usurper, Nadir Kouli
The book had several editions, and from being a merchant Hanway
became a writer Once he took up the pen he never dropped xt and pro-
duced a large number of books and pamphlets His bibliography lists
over seventy items, which cover a very wide field because Hanway had
become increasingly interested in public affairs He wrote about the
naturalization of the Jews and about the improvement of the highways
of London He uas a cofoundcrof the Manne Society that endeavored
to supply sailors to the navy In 1758 he was appointed a governor of
the Foundling Hospital, and he drew up a ‘Plan for a Magdalen House
for Repentant Prostitutes ” He organized a club for young chimney
sweeps, wrote against “vailsgivmg,' or tipping, and against midnight
routs He advocated solitary confinement of prisoners and had much ad
vice to give, ' to a Daughter on her going to Service," ' from a Farmer to
his Daughter," "Moral and Religious Advice to Soldiers/ "Moral and
Religious Advice to Seamen," ‘ Earnest Advice, partiailarly to Persons
who live in an habitual Neglect of our Lord s Supper ’ He had praycis
for everybody, ‘ for the Parish Poor/ "Prayers suited to the Condition of
the AVomen,’ * Prayers for various occasions ” He wanted more Sunday
schools and a more vigorous police, and he was supposed to have been
one of the first to walk the streets of London armed with an umbrella
* From Hanvv'ay to Chamberlain, a History of the Umbrella in BnW
Life —what a beautiful subject for a doctoral dissertationl

Hanway's endeavors to improve the lot of the infant parish poor repre-
sent by far the most important of his philanthropic activities* Con i
lions in the pansh woiUiouscs were scandalous An infantile death rate
of 100 per cent was not uncommon Hanway’s publications and his ^
leniless efforts were responsible for two Parliamentary bills which sav

4 Ste Em«t CaulBeld i otecllcnt boot, Tfce Infant IVel/ure m

Cfr»lUf7,Ncw VoTk. 1®3I

A LITERARY CONTROX'ERSY OVER TEA 221

hundreds of human lives: one passed in 1761 that provided for the regis-
^tion of infants under parish care, and one of 1767 that directed that
"all Parish Infants belonging to the Parishes within the Bills of Mor-
ta]it>^ shall not be nursed in the IVorkhouses, but be sent to nune a
certain number of miles out of Totvn, Until they are six years old, under
the care of Guardians, to be elected tricnnially, for the express purpose of
taking Care of them."

In 1756 Hanway published a book with the title: A Journal of Eight Days
Journey from Portsmouth to Kingston upon Thames; through South-
ampton, Wiltshire, etc. with Miscellaneous Thoughts, Moral and Re-
ligious; in Sixty-four Letters: Addressed to Two Ladies of the Partie.

It is a most insipid book. From Portsmouth to Southampton Hanway
makes remarks on buildings and nunneries. From Southampton to White
Parish he reflects on tombstones. At Salisbury he has thoughts on educa-
tion, church music, and oratorios, on the theatre, and on divine poetry.
From Salisbury to Langford he meditates about death and temperance.
Till he arrives at Stounon he "ridicules ^ female fondness for animals and
birds; and thence makes many weighty reflections”— on matrimony and
such subjects. Thus he goes on disserting endlessly, and the reader thanks
heaven svhen the party discussing "the advantages of female conversa-
tion” finally reaches its destination.

The book was printed for presentation only and was not on sale, but
the follosving year Hanway published a second edition, corrected and
enlarged, in two volumes which ivere sold. The second volume con-
tained: An essay on tea, considered as pernicious to health, obstructing
industry, and impoverishing the nation; also an account of its growth,
and great consumption in these kingdoms, with several political reflec-
tions; and thoughts on public love: in thirty-two letters to two ladies.

Hanway had made a discovery. He had found the enemy that tvas
sapping the vitality of the British fieople and svas threatening it with
physical, moral, and economic decay. It %vas that exotic shrub: tea. “O
tempora, o mores!"

After an introduction on the growth of tea, the Chinese manner of
drinking it and its introduction into England, an introduction that fills
three letters to Mrs. O., Hansvay launches his attack. Let us briefly sum-
marize his argument.

222 ON THE HISTORY OE MEDICINE

==gitsl£i£|.

sweet creitures of your sex. languish with a w cal. dige .1

lassitudes, melancholy, and twenty disorders, which in 'P'' , J

have yet no names, except the general one “t ^ a^„hi„etei

them change their diet, and among other ^ ,„ed w

,t IS more than probable the greatest part of them will be res

‘’tot’tea IS also very bad for the teeth "The women ^
provinces who sip tea from morning till night, are ^ j; “

Ld teeth They also looh palhd, and a^rvai!

feminine disorders arising from a relaxed habit . ^

Not a nutriment, not a liquid to quench thirst, lor the ^ fjo

thirsty . it IS an idle custom, an absurd expense, ‘'"f '"E “ '
tastic desires and bad habits' . it drives more people to the d
all other debaucheries, and ' were the college of pl'l'S’'^"' „ tht

I apprehend they would do more real benefit to this country,

Conclave ever did to the cause of true religion at Rome , j,js

Tea kills people Were we to reckon that only one mat
annually of this slow poison, out of two millions of 'f b„n

would suffer the heavy loss of two thousand subjects Since ^
in fashion even suicide has been more familiar than in P j,„jses
kills not only adults but innocent infants Indeed P -,o

spend their allowances on tea, how could they feed the chil r
Tea not only destroys the people s health and very life
ous economic losses to the country Hanway estimated tea

consumption of tea amounted to five million pounds, me u ^
that was not imported legally but was smuggled m The pric so

varied from 2 shillings 6 pence to 20 shillings, averaging
that the total expenditure was 1,250 000 pounds
6 Hanway op cit pp 30 31

6 Ibid p 33

7 Jbid p 48
Blind p 74

9 Ibid p 77

10 Jbid j p 110

A UTERARY CONTROVERSY OVER TEA

223

To this ^vas lo be added the amount of money spent for the sugar that
was consumed with the tea, about 5 pounds of sugar to 1 pound of tea.
Counting three fourths of the sugar at 4 pence and one fourth at 8 pence,
the expenditure amounted to 525,000 pounds.

The next item in the bill was the time lost by working people in drink-
ing tea. Supposing only one million servants, mechanics, and laboring
people lost time in such a way. counting only 2S0 days and one hour in
twelve lost on such days, with daily wages amounting to 6 pence, then
tea would cost the nation in this instance 583,333 pounds.

The time lost by fine ladies and gentlemen was, of course, considered
invaluable, but rvhat had to be counted rvas the tea equipages of 333,333
families including two million tea drinkers. At 5 shillings each this item
amounted to 83,333 pounds.

And finally one had to count the expense of teakettles and coals, con-
sidering that in certain seasons people made fire merely on account of
their tea. At 15 shillings a year the charge amounted to 249,999.

And thus the people of Great Britain, not counting Ireland, spent an-
nually 2,691,665 pounds. For what? For tea, for their otm destruction.
This was taking “a political and prudential view”; it was the grand object
of Hanway’s lucubrations, a language that Britishers would understand.^^

But then was not the East India Company to be blamed for importing
the pernicious leaves and draining so much gold and silver from the
country to China? Of course not. Hamvay remained loyal to his fellow
merchants. “The East-India Company ought to be considered by far the
most respectable, and most useful trading company in the nation.”'® Its
directors “may not think themselves obliged to be arithmetical politi-
cians, nor to enter upon the consideration of what the nation gains or
loses.” “If it [the tea trade] is profitable to them, no body can doubt that
it is a less evil to the nation, to pay nine-pence, or a shilling a pound to
the Chmes-e, srrd enjoy aii ^he profit arisiog froai the jwvigawcw, thao to
employ French or English smu^ling-vessels, to bring over tea, for svhich
rve pay from eighteen-pence to three shillings to the French, Dutch,
Stvedes, Danes, and Prussians.”'*

An argument frequently brought forth in favor of the tea trade was
that it employed “five or six hundred seamen, and, consequently, many
other industrious subjects to support them, together with six ships, which

n Zbf<i.,pp. 149-154.

I2i6,d^p, 179,

isji/d-.p. 181.

224

ON THE HISTORY OF MEDICINE

A rnnron ' “ The tea trade also brought in a revenue
we annually send to Canto ^ may be

oE about 350,000 pounds Hanway argued, one

considered o£ great utility to seamen as the whole China

seventy gun ship of war wou r compensated easily by

trade And as to the loss of reve - 1 ^ and silver lace,

importing less iron from Sweden imposi S » ^ gentlemen

embroidery, or other gold or silver navy ercepted)

belonging to the king’s ‘'"'-“‘■old, and to the ^^„ants“

or by taxes on jewels, on wigs, on P'^^ng ^

The reader is invited to stop f” “ ” depicted conditions that

piece to Hamvay’s book, where the ar P Boxes are

cannot hut move us to tears A ship '’“J'""'" ean easily g«®

being unloaded, and from the Cl>™se characters

what their pernicious content must be T P P England s wealth
of gold and silver are walking to the shore to g (o„ground--

for Chinese poison A “ ^"8 ‘f. 1™' ’^'The child playing w*

for Chinese poison A family, an tngiis i '■ jaymg v

sipping tea, forgetful of the Jd What do they care?

the fire has upset the teakettle and is being b

‘I!" fZ.‘re the%«uu ofthe pernicious habit of

They sip their tea One ot tnem w dnj-u; . e ^jdous
a house in rums England s future, the result of the pern
tea drinking 0 tempora. o mores

a drinking 0 tempora. o mores „,,rrelam cups and our

What IS the remedy? IE we must retain ou p e a*

_ . 1 .-- eirtnt mfiiKions made from native

What IS tne rcnicuyr ih a..*.. . _

stppmg, then let us dtmk infusions made „ycoyal, hote

ground tvy, balm, lavender, thyme mint, rose W’ P harm'c®

found, «efo.l, sorrel, angeh^ cowsh^ - p-

hound, trefoil, sorrel, angelica, “«®“P’ .^e choicest tea

and are more delicious to an undebauched taste jj^iJal

let us present glasses of sugared water, or mi ^

refreshments, which can be procured without got g example W

The mid infatuation of drinking tea took its ri ^bc

example it is supported, and example only can abol t.
suppression of this dangerous custom depends cn Y
of the ladies of tank of this country Should *cy g jnterest to have
the many headed monster, Hanway rvould employ

a statue erected to their memory, „„rpos'> b"'

not ol gold or silver, tor 1 fancy we ahali want these petals for o
of brass or marble which will Iasi as long It shall be mscri

Ulbid.'p 184
isjfcjd p 238 ff
ie/bid,p 225ff

A UTERARY CONTROVERSY OVER TEA

225

M.DCaLV.

the remembrance
of the fair guanlian spirits of
BRITAIN,

Whose influence and example
abolished the use of
a Chinese drug called
TEA.

the infusion of which had been for many years
drank in these realms and dominions,
injuring the health,
obstructing the industry,
wasting the fortunes,
and exporting ibe riches,
of his majesty's liege subjects:
fccfec.”

Hamvay’s philippic did not remain unanstvered, and counterattacks came
from two very distinguished quarters. No English writer could possibly
have had more personal experience in the subject than Samuel Johnson,
who tvas known to be an inveterate tea drinker, tvho once drank tv/enty*
hve cups at a sitting. At the time when Hanu^ay’s book was published
Johnson was editor o£ the short-lived Literary Magazine, or I7nive«af
Review.

He felt challenged by the essay on tea and reviewed the book in his
journal,** not without admitting that he was highly prejudiced in the
matter; “but it can scarcely be candid, not to make a previous declara-
tion, that be [Hantvay] is to expect little justice from the author of this
extract, a hardened and shameless tea drinker, tvho has for twenty yean
diluted his meals with only the infusion of this fascinating plant, whose
kettle has scarcely time to cool, who with Tea amuses the evening, w’ith
Tea solaces the midnights, and with Tea svclcomes the morning.”

Johnson gives lengthy quotations from Hanway and ridicules the
dreadful effects of tea he pictures, of tvhich “some are perhaps imaginary,
and some may have another cause. That there is less beauty in the
present race of females, than in those who entered the tvorld svith us, all

IT tbid.. pp. 276-277.

18 LittroTy Magazine, or Vniverjat Reznezu 2:161-167, 1757.

226

ON THE HISTORY OF MEDICINE

Ot US are urCned ro thru, ou who™ •>eamy^ ceased bu. our

fathers and grandfathers made the same ^ „etv

posterity ts lU still find beauties irresistibly powerful Gran
ous diseases are more frequent than in the past.

OU5 UOcaaw MS,. —

thu new race ot evih mil not be ^

general languor is the effect of general luxu^ o ge arauseraftiB

found among tea drinkers the reason is Uia. tea i. one of the sm„d
of the idle and lusurious The whole mode of life is ^banged ' "7 a

labour esery eaercise that strengthened the nerves
fallen into disuse The inliabitanls ate crowded together in pop
occasion of life requires much motion ever, one “ „„,sgts d

the rich and delicate seldom pass from one street to ano ,
pleasure Yet we eat and dtml or strive to eat and dnnk 1
huntresses the farmers and the housewiscs of the former g j,

pass ten hours in bed and eight at cards and the greater pa y„natural m iH
the table are taught to impute to tea all the diseases which
iu pans may chance lo bring upon them

lU paiis UlAJ S.M Msas-tj V-J--.. — —

Tea, moreover, is as a rule not consumed m enormous ibin

people drink more than three cups, and it is the tea tabl
the tea itself that brings them together .ludious

The proper use ot tea is ‘ to amuse the idle, and relax me s
dilute the full meals ot those who cannot use exercise, and
abstinence " There is no doubt that time is lost in ‘b» ^ ,l,)t

but this should not affect the national economy "because I j,

any isork Tcmams undone for ivant of hands Our manu ac u ^3]^-

any Asork remains undone for ivant of hands Our man . i.yofsalc"

be limited, not by the possibility of -uork, but by the possi i » -piicj
_ . . j t f— .K- i«,.,Ar rlnsses as It sup _

be limited, not by the possibility ot -uotk, out oy me ^ ^ supp''^
Tea, hoisever, is not a proper drink for the lower classes a
no strength to labour, or relief to disease, but gratifies i e
nourishing the body ”

lourisning iiic uouy noint

lohnson for once agrees with Hanuiy, namely m the po

. . . , «of hean arg>

that 1^'

itncnt 1'

jonnson lor once agrees wiiii ijr,

employment of fne to six hundred sailors should not be an jialf

no iiui mesh

favor ot the tea trade because, he adds, ‘‘I am told,
commonly a third part perish in the voyage,” so that t le thit

annually two hundred men in the prime of life and "C ijcginn’^s

the trade to China has destroyed ten thousand men since
of this century ” ,f it

Johnson’s conclusion is “If tea be thus pernicious, ^.n-

our country, if it raises temptation, and gives opportunity
mcrce, which I have always looked on as one of the strong^
the incfTicacy of our law, the weakness of our govemmen .

A LITERARY CONTROVERSY OVER TEA

227

ruption of our people, let us at once resolve to prohibit it for ever.” But
Johnson is convinced that these are not the effects of that "fascinating
plant.”

Hanway resented the review. His secretary and biographer, John Pugh,
said of it;^®

The Doctor [Johnson], in his warmth, perceived not that Mr. Hanway’s remarks
were not intended for people in his line of life, and by this essay convinced their
mutual friends, that he was not more superior to his adversary in learning, than
inferior to him in a0ability and social benevolence.

The other refutation of Hanway came from Oliver Goldsmith ivho in
1757 was living with the bookseller Griffiths and was ivorking for his
periodical, The Monthly Review or Literary Journal. In the July num*
ber of 1757*° he discussed Hanway’s book. His review is much shorter
and much kinder in tone than that of Johnson, beginning:

Mr. Hanway, who has already obliged the public with an account of his Travels
into distant parts of the world, here presents die Reader with the result of his
Travels nearer home. This Journal was. perhaps, at first designed for the amme*
xnent of his friends, and by their too partial applame he might have been tempted
to send it into the world; however, he an lose little reputation tbo’ he should not
succeed in an attempt of such a nature as this;** especially as he has already shewn
himself equal to subjects and undertakings that require much greater abilities.
Novelty of thought, and elegance oi expression, are what we chieSy require, in
treating on topics with whi^ the public are already acquainted: but the art of
placing trite materials in new and striking lights, annot be reckoned among the
excellencies of this Gentleman; who generally enforces his opinions by arguments
rather obvious than new, and that convey more conviction than pleasure to the
Reader.

It will be remembered that Oliver Goldsmith had studied medicine at
Edinburgh although he had never graduated.** He resented the fact that
Hanway discussed the effects of a drug and condemned it without being
a doctor. After having summarized Hanway's arguments against tea and
havingquoted some essential passages. Goldsmith ended his review with
the following svords:

Pugh, op. eit., p. 154.

20 i7:50-54.

21 An allusion to a widely circulated &on mot of Johnson who had said that Hanway had
acquired some reputation by traveling abroad, but had lost it all by traveling at home.
See Boswell’s Ij'/e of Johnson, Oxford, 1887, vobll, p. 122.

22 He described Monro as the one greai professor, and the rest of the doctor-teachen
as only less afflicting to their studeno than they must be to their palienis. See John lonter.
The Life and Times of Oliver Goldsmith, London. 1871, voL I. p. 49.

228 ON THE HISTORY OF MEDICINE

When he [Henwey] treet. o! Tea in h.. .Mnmed med.rf eapaaty ip^
by „„ means 1, he an adept in phys e .ndeed .. « no. to “P ^

Gentleman can be acquainted vnd. a «nence that requ.tea so J

m the acqatstuon and tberefote »e ma, totgtve ht. error, P°;"” ® ^

out but i! to be unacquainted with tbe medical art indicates ^

knowledge yet perhaps it argue, some sram of prudence to speak 0
which out acquirements are not adequate

Yet alter all why so violent an out-cry against this devoted »«'' '
luxury? Every nation that is rich bath had and will have its a
Abridge the people in one they generally run into
ludge which will be most conduave to cither mental or bodily heal
beverage of a modem fine Lady or the strong beer and stronger w
great-grandmother?

While I am writing this paper-sippmg many cups of fragrant
and Souchong-I cannot help feeling uneasy I want to be
impartial but I cannot conceal to myself that 1 thoroughly d‘* >
way Not because in this particular controversy I happen
Johnson s side but because I have a profound aversion to the
ph/anthropist that Hamvay represents re honest

There cannot be the slightest doubt that men like Hanway we
and sincere and that they did a great deal of good
society in which birth and wealth gave all privileges and t e
man had little chance of escaping his servitude they succeeded
mg outrageous conditions in mitigating the hard lot of * can

people and in saving many human lives Is this not enoug y^jious
we not admire these men without reservation? I think there

reasons >, rd to heat"

One IS that the self righteousness of many of them
their holier than thou attitude their constant moralizing w at

their writings so intolerable Much more serious is that t ey^^^^ system
tempted to attack the social evils at their root They accepte panted
under which they lived with all its injustices They took it o
that the rich was rich and the poor poor and that it was t e
duty to serve the rich and to increase his wealth They j-new
asylums and improved the lot of the infant parish poor an
this would provide sailors for the navy and domestic servants
They accepted it as an axiom that the East India Company jbef

dividends for their stockholders and excused them if by so

A LITERARY CONTROVERSY OVER TEA

229

poisoned the nation. It sounds like irony when Hantvay states that “the
life of an infant bom to labor, politically considered, may happen to be
of more value than the life of a duke; and the laws of humanity permit of
no distinctions in what is essential to the preservation of life,"^ since we
know that the lot of the infant bom to labor was to labor for the duke.

How different were the Quakei^, men like ^Villiam and Samuel Tuke
who did great social works without moralizing, or, then, the revolu-
tionists like Rousseau who attacked the social evils at their root.

Poor Hanwayl If he came back to life today he would be terrified beyond
words to find that, while the population of Great Britain increased about
five times, its consumption of tea during the same period increased over
eighty times, from five million pounds to 416,152,552 pounds in 1927.®*
And he would be extremely astonished to find that, in spite of this flood
of tea, the nation, against all his expectations, did not decay. He would
find that John Bull is as tough as ever and just now is putting up a gal-
lant fight against a ruthless aggressor. Since he was an honest man and
sincere patriot, Jonas Hanway, I am sure, would be delighted and would
gladly admit— that he was wrong.

ss Hanway, op. cit., p. 112.

Si Encyclopaedia Britannicajod. H.

PERSONAL HISTORY

MEDICAL HISTORY IN THE
UNITED STATES:
PAST— PRESENT— FUTURE:
A VALEDICTORY ADDRESS

^^L-VoOKING through my files I found that I had the honor to address
this club for the first time on October 26, 1931. 1 was then in charge of
the Institute of the History of Medicine at the University of Leipzig and
had come for several months to Johns Hopkins as visiting lecturer. Field*
ing H. Garrison was President of the club, John Rathbone Oliver was
its Secretary, and Dr. Welch was the driving spirit who attracted large
crowds. ^Vheneve^ it was known that he would attend a meeting of the
club, and he rarely missed one, you could count on a capacity audience
because faculty members, students, doctors from the city, personal
friends, men and women, flocked to the lecture hall to see him, to greet
him, to listen to the remarks rvhich he invariably made after every paper,
and which sometimes were as long as the paper itself.

1 \vas well aware that I was addressing the oldest society of medical
history anytvhere in the ^vorid ivhich was still active. The corresponding
French, German, and Italian societies were all organized after 1900, while
this club was founded in the library of the Johns Hopkins Hospital on
the tenth of November, 1890, by Osier, Welch, Kelly, and some thirty
other Hopkins doctors. When its fiftieth anniversary was celebrated in
1940, one of the founders and prime movers. Dr. Hotvard A. Kelly, ^vas
still alive and addressed the club then as he had done fifty yean before.

Read before The Johia Hopkins Medical Hlstwy Club on May 14, 1947.

234

ON THE HISTORY OF MEDICINE

Sixteen years ago I discussed before this club the ivork of the Leipzig
Institute, which had been founded m 1905 by Karl Sudhoff and to which
1 had been called in 1925 Today on the eve of returning to Europe I
would like to talk about the Johns Hopkins Institute of the History of
Medicine I do not, however, wish to discuss it separately but rather as
one link in the development of studies m medical history m this country
This development, as a matter of fact, went very much along the same
lines as in Europe Until the nineteenth century, medical history on both
continents was an integral part of medicine The approach to the past
was not a critical historical one but %vas taken from a medical point of
view Books were read for their factual content, irrespective of the period
at which they had been written Doctors read them in order to learn how
to treat their patients, and they thought that they could gam practical
knowledge from Hippocrates as well as from Sydenham The medical
apprentice m America, browsing in the library of his teacher, found
Hippocratic treatises in Latin or English translation, and the modern
books he read, the works of Sydenham Boerhaave, later the physiology
of Haller and the works of Brown and Cullen, were full of historical
references When the medical school of the University of Pennsylvania
was founded m 1765, it had no need for a special chair of medical history
because all members of the early faailty. Rush, Morgan, Shippen Kuhn
were well versed in the subject and in their lectures and writings con

stantly referred to the past of medicine as a matter of course

So far as I can see the first man who might be considered a professor
of the history of medicine m America was Robley DungUson who was
called to the University of Virginia m 1825 Thomas Jefferson then
Rector of the university, insisted that he should teach to the best of his
ability and with due diligence the history of the progress and theories o
medicine But since the terms of his appointment foresaw that he shou
m addition teach anatomy, surgery, physiology, materia meuVt'U', a
pharmacy, we can hardly consider him a full time professor of medica
history His lecture notes were published by his son in 1872 and became

a well liked textbook on the subject

I will not dwell upon this early period, will not discuss the biographies
and biographic dictionaries written at the time, the historical orations
that seemed to have been very popular for a while, nor the place taken 1
historical considerations m medical literature in general Miss Genevie
Miller plans to investigate this period some day and will I am sure
forth many interesting facts I rather wish to take you now to the

MEDICAL HISTORY IN THE UNITED STATES 235

quarter ot the nineteenth century, to the time when American medicine
was making a great effort to catch up mth Europe, one in which it sue-
ceeded so ivell.

Medicine ■ts’as no longer the craft it had been, but it had become very
scientific. A new pathology and clinic had established well-defined dis-
ease entities, and in examining a patient the doctor could no longer be
satisfied with ascertaining that he tvas suffering from a continuous or
intermittent fever, from a bilious attack or some equally vague condition.
"With all scientific means available he now had to make an accurate diag-
nosis of the disease and of the individual, and this determined his further
actions.

Was there still room for a study of medical histoiy'? The old literature
reflected a different concept of disease, knew nothing of the new methods
of diagnosis, was ignorant of many nesv treatments, surgical and others. It
is highly significant that the men who inaugurated our hospital and
school of medicine and made it famous in the world, the men who revo-
lutionized medical education in this country and brought modem scien-
tific medicine to it, who probably more than anybody else in American
medicine made history at that time, that they were all keenly interested
in medical history. They were medical humanists who were conscious of
the point in the historical development at which they stood, Their teach-
ing tvas scientific but imbued with humane and historical considerations,
and today still you may recognize their students by their broader culture.

In this development John Shaw Billings played a decisive part which
has sometimes not been appreciated sufficiently because his was an austere
personality very different from the jovial nature of an Osier or a IVelch.
On the occasion of the hundredth annivenary of his birth in 1938 we
tried to do justice to the enormous contribution he made to the school,
to medical education, and to medical history.^

As early as 1876 Billings accepted an appointment as Lecturer in the
History of Medicine at the newly opened Johns Hopkins University.
During the academic year 1877-1878 he gave a famous series of twenty
lectures on medical history, medical legislation, and medical education.
In an address to the Medical and Chiniigical Faculty of the State of
Maryland delivered in 1883 he made a strong plea for a course in the
history and bibliography of medicine to be given at the Hopkins School
of Medicine whenever it would be opened. And on another occasion he

r See the John Shaw Billings Jferaorial Number. BuUetin of the Jnstitule of the HUtoij
of Medicine tf:223-S98, 1938.

2S6

ON THE HISTORY OF MEDICINE

made the statement that ‘ it is very rare that a man ignorant o£ the his
tory and literature o£ his profession achieves great success ’ ^

It was in the 1870 s that he planned the Index Catalogue of the S«r
geon General’s Library and the Index Medtcus and thus made the
greatest possible contribution to the history and bibliography of medi
cine When the school of mediane was opened in 1893 he was appointed
Lecturer m the History and Literature of Medicine and gave courses
until 1904

The Johns Hopkins Medical History Club, or rather The Johns Hop
kins Hospital Histoncal Club, as it was named at the time of its founds
tion, met regularly from 1890 until 1905 either in the library of the hos
pital or in the homes of the members, and Eugene Cordell of tlie Unuer
sity of Maryland did not exaggerate when he made the statement that the
club had exercised a profound influence not only locally but throughout
the entire country Many able papers have been read before it, and there
are few who have any claims to distinction in this field m the United
States who have not been its guests ' This was very true and we find the
medicohistoncal activities of the entire country reflected m some way or
other in the papers read before the club, many of which were published
m the Bulletin of the Johns Hopktns Hospital Many of these papers de
serve to be reprinted today, and I am sure that they ivould make a very at
tractive volume I also wish that someone ivould ivnte the history of the
club, because I consider it extremely significant that the school which at
that time made the greatest effort to develop the scientific foundations of
American medicine ivas the one which from the very beginning emph^
sized the humanistic approach to medicine This did not happen by acci
dent but was the reflection of a certain mental attitude about ishich I'C
ivould like to knoiv more, and a historical study ivould provide an analy
SIS from ivhich ive could learn ajrrcat deal

"When Osier left Baltimore m 1905, the club interrupted its acmitiM
for a while but resumed them later, and as you know, it is flourishing
today Similar clubs were founded in the course of time mother unnetti
ties and communities and a survey made m 1937 revealed the rat c
astonishing fact tliat at that time thirty eight local medical history group
were functioning in the United States and seven in Canada ’ The coun

2 See Sanford V Larkey "John Shaw Btllifigs and the History of ^fed^dne Pullff "
the Iiuliluu of the History ef Mediane 6 360 1938 Statfs.'

8 Sec H E Sigerut Medical History in the Medical Schools of the Media*

Bulfelin 0/ the Htstory of ilfedinne 7 637 662 1939 and "Medical History In the s
Schools of Canada " ibid S 503 303 1940 The Canadian survey was made m 1933

MEDICAL HISTORY IN THE UNITED STATES 237

tiy in addition had a national organization, the American Assoaalwn of
the Hislory of Medicine, founded alter the first World War and enlarged
■ in structure and scope in 1938. There obviously is a great diversity among
•the’various local groups. Some are very active and some
in universities consist mostly of faculty members, while
dent societies; some are historical sections of medical societies, others
medical history sections of historical societi«. But

a group, limited as its activities may be, there is a focus of humannm
wM* cannot but exert a certain innueuce on the ^ ™ „

The early day, of the Johns Hopkins “''b ^

large medicohistorical collections were a«emb ed. Th= “ h

played an extremely important part m American
Lrope old medical books, manuscript and printed,
university library as a matter of course, because most
founded in the late Middle Casslno

•that they used at the time are still there. I J i_ , 1 ,. earfy Middle

or St. Gall, medical manuscripts ,ytten ^ In

Ages are still on the spot where they a medical books.

America, however, the early colonists y ^

Many were used up and fell to pieces in P research and the col-
documents are the chief tools of tools, using

lectors who spent time and money in c g , j conditions that

them, and then donating them effL the Sur-

made further research possible. Throug i J national

geon General’s Library in Wash.n^on collec-

medical library but also the country s ore country of such

tion. One such center, however, .vas not enough m a co J
vast dimensions, and this is svhere the private collecto pp

creating nesv centers.

a very distinguished

In this movement the Baltimore P University, and

part. Osier’s choice collection is Under the leadership of

its catalogue is one of our major b.bli^pWes^

Dr. W. W. Francis the collection has b annually by the

and it is not by accident that Ae xigdidne for the best essay pre-

American Association of of medicine, svas granted

sented by an American or Camd an student
in two consecutive years to Me . stu^^

I Those ot Monte Casslno tewpotaiily mi»
soon as the abbey is rebuilt.

238

ON THE HISTORY OF MEDICINE

Howard A Kelly and ‘WilUain S Halsted were also keen collectors,
whose books are now the prized possession of the William H Welch
Medical Library A Baltimore friend of Osier was Dr Henry Barton
Jacobs, who devoted a lifetime to the collecting of books and documents
on the history of vaccination and of tuberculosis, on Rabelais Laennec
and Pasteur Housed in an especially designed room in the Welch library,
the collection has rendered great services to the Institute of the History
of Medicine and has been ividely used in research, teaching and m the
preparation of exhibits A four volume catalogue is in preparation each
volume of which ts intended to be a basic reference book of its field At
Hopkins Harvey Cushing became interested in old medical books and
today his unique collection, particularly rich in Vesaliana and other
Renaissance literature, is the backbone of the Historical Library of the
Yale School of Medicine and, together with the collections of John F
Fulton and Arnold C Klebs, the nucleus of what may develop into a very
important institute

I have mentioned only a few collectors who on account of their Hop-
kins connection are particularly close to our heart, but at the same time
all over the country doctors with love and enthusiasm were purchasing
old medical books, building up collections which ultimately found their
way into a library and thus became available to students in the field An
interesting study could be written on medical book collecting m this
country What seems particularly important to me is that students should
know where collections are located and what they contain The Army
Medical Library has its Index Catalogue, and catalogues have been pub
lished of other outstanding collections, many of which have been m
eluded m the Union Catalogue of the Library of Congress It is the
smaller collections that frequently escape the attention of scholars Thus
the student of Paracelsus must know that we are fortunate in having two
valuable collections of Paracelsiana in the country, the Constantine He*
ring Collection m the Library of Hahnemann Medical College in Phda
delphia and the Robert E Scblueier Collection in the Library of the t
Louis Medical Society The student of balneology will find a collection
of books on the subject at Saratoga Springs, and in a similar way we ha'C
many collections scattered all over the country that may not necessa j
be large but may be most useful The Bulletin of the History of Medicin
published a senes of articles under the general heading ‘Medical His
Collections m the United States and Canada’ giving either descnptio
or check lists of just such collectiom I hope that this will be continu

MEDICAL HISTORY IN THE UNITED STATES 239

and will lead ultimately to the compilation of a much-needed handbook.®
In the beginning of our century the teaching of medical history in the
medical schools of the country had made little progress. In 1904 Eugene
Cordell, die distinguished historian of medicine of Maryland, Honorary
Professor of Medical History and Librarian of the Univenity of Mary-
land School of Medicine, was President of the Medical and Chirurgical
Faculty and delivered his presidential address on "The Importance of
the Study of the History of Medicine."® He had surveyed conditions in
the fourteen leading medical schools (Harvard, Yale, Cornell, New York,
Columbia, Pennsylvania, Virginia, Chicago, Michigan, Tulane, Johns
Hopkins, Maryland, Minnesota) and had found that only three (Penn-
sylvania, Maryland, Minnesota) were offering full courses of fourteen
to sixteen lectures. At Johns Hopkins, Billings was giving only three lec-
tures a year at that time, but the students took an active part in the life
of the club. At Yale five or six lectures were given by the professor of
therapeutics, and Harvard reported that a course had been attempted
but had been discontinued for lack of interest. Cordell concluded his

report with a very strong statement:’

Let lu now sum up some of the advanuges ot the study of medical history that
have been pointed out in this address:

1. It teaches what and how to investigate.

2. It is the best antidote we know against egotism, error and despondency.

3. It inacascs knowledge, gratifies natural and laudable curiosity, roa ens

view and strengthens the judgment. , .

4. It is a rich mine from which may be brought to b'ght many neg ecte or

looked discoveries of value. , , , „ .

5. It furnishes the stimulus of high ideals which we poor, wea mor as ^
have ever before us; it teaches our students to venerate what is g , to ^tis

best traditions, and strengthens the common bond of the profession. .up

6. It is the lulfilmcnl of a duiy-that o( cherishing the memories, the vir .
achievements, ot a class which has benefited the world as no o cr as, an

we may feel proud that we arc members. , . .

Having now shown the value-nay, I should rather say the J ,p,chin? So

of medical history. I shall conclude with a few words regarding its teaming,
important a branch should receive the highest consideration, t s ou
no desultory fashion, but as thoroughly as any other. There ou jjjouid

the history of medicine in every university. A systematic course o

“The very good Handbook of Medical Library Practice, edited ^7

American Library Association. 1943, has a brief chapter l
A merica [pp. 295-302] which, however. Includes only the outstanding co •

« It was published in the Medical Library and HUtoncal Journal 2:268-282. 1904.
281.

1 medical historical collections in

240

ON THE HISTORY OF MEDICINE

be required in addition to the lectures which should be not less than sixteen to
twenty in number It should be made a subject of examination for all experience
proves that m no other way can the attendance of the students be enforced The ume
IS near at hand when the standing of universities will be judged by their attitude to
this branch and when it will be assigned a front rank m the curriculum

We are still far from having fulfilled Cordell s postulates, although
progress has been achieved, as Ave shall see in a moment

At that time the writing of medical history in America was primarily
the work of amateurs An amateur is a man who loves a subject who
engages in it as a labor of Jove Far be it from me to minimize the great
contributions that amateurs have made and I am sure, will continue to
make to medical history A practicing physician, moreover, if he has the
basic preparation and enthusiasm may come to master methods
of historical and philological research and while still engaged in practice
may become an outstanding expert Numerous examples could be atcd
on the subject

On the whole however, it must be admitted that the field of research
open to amateurs is limited particularly today when very few young
people come to medical school with classical training and in spite or
requirements very few have more than a superficial knowledge of any
modem foreign language This restricts their field of historical researm
primarily to local history * And yet so much remains to be done in the
whole wide field of medical history, so much source matenal is still un
tapped so many re examinations and revaluations need to be made m
medicine of antiquiiy the Middle Ages m East and West the far East
the Renaissance and even m medicine of the last three hundred years
Strange as it sounds we do not yet have an adequate monograph of sue
an important episode as the school of Salerno Most of the texts are
printed but no one has attempted as yet to analyze and evaluate t e*
medical content No monograph has ever been written on such
Ual movements as those of the latrochcmists and latrophysicists In
field of Arabic medicine most elementary work the cataloguing of rue
cal manuscripts and the publication of basic texts never printed ° ^
still remains to be done And as to classical antiquity, the Corjins
corum Graecorum and the Corpus Medicorum Latinorum are far ^
finished An infinity of studies remains to be made on the history o ^

son th?* subj<« see the fllumiflatfng articles of Genevieve MiUcr
Amencan Medical Histoiy SuUetln of the Ilutory of Medtctne J7 1 8 1^M5 tfi

field J Dell Jr Suggestions tor Research in the Local History of Medicine m
States ibid 460 476

MEDICAL HISTORY IN THE UNITED STATES 241

eases, of attempts to promote health, to prevent illness, to cure and re-
habilitate the sick in antiquity and thereafter. Such work, however, re-
quires expert knowledge, people trained in the methods of historical and
philological research, men and rvomen tvho can devote their entire time
and energy to the task, because historical research is frightfully time con-
sutning.

This is why the creation of the Institute of the History of Medicine at
this university in 1929 acquired such significance. For the first time in
America, scholars tvere given an opportunity to devote all their efforts
to medical history. We must 6c deeply grateful to Dr. Welch for the
vision and foresight he had in creating this center. Keenly interested in
medical history, he, unlike his colleagues, svas never a collector of old
books. He tvas presented with many rarities, but as soon as he had read
them he passed them on to the library. We are indebted to the Rocke-
feller Foundation, which made the establishment of the institute possible
through various generous grants and even increased its yearly appropria*
tion during the difficult days of the depression. I would also like to recall
here the great services that Dr. Lctvis A. ^Veed, Director of the School of
Medicine, rendered to our cause. He look a most active part in planning
the building of the Welch Medical Library, and after having worked in
it for over fifteen years I can testify that the plan was a very good one.

It rvas in 1932 that I took over after Dr. Welch had retired from the
last of his many positions in this university. The institute tvas the only
one of its kind in America, and it seemed obvious to me that vre should
make an effort to cover as wide a field of medical history as possible. This,
however, required a highly specialized and diversified staff. Dr. John
Rathbone Oliver was an associate in the department svhen I came. He
was a highly cultured gentleman of whom I soon became very fond. A
priest, a classical philologist, practicing psychiatrist, and a popular nov-
elist in addition, he obviously had little time to spare for the department.
Dr. Fielding H. Garrison, after his reti^ment from the Surgeon Gen-
eral’s Library in Washington, had been appointed Librarian of the
Welch Medical Library and Lecturer in the History of Medicine. He
brought great prestige to the institute, but his energy was largely ab-
sorbed by being the librarian of the fifth largest medical library in the
country, of the largest university medical library, and this at a time svhen

242

ON THE HISTORY OF MEDICINE

extensive collections were being consolidated and an enormous amount
of administrative work had to be done*

I soon realized that I would have to bring some staff members over
from Europe Dr Owsei Terakm came with me in 1932 He had been
my associate and Prwatdozent at the University of Leipzig and continued
to be my senior associate in Baltimore He is one of the few men whose
enthusiasm for medical history was such that he entered the field in his
student days and never left it As a young student he read a seminar paper
which was so good and so original that I immediately published it, and
I have quoted it many times since then ** His doctoral dissertation was
an important contribution to the problems raised by the Corpus Hip

raticum After having completed his internship in medicine, he
joined my staff m Leipzig and wherever he felt a gap in his philological
equipment, whether it was in Arabic or Assyrian, he took courses and
filled the gap He never sought cheap and quick success but took up large
and difficult subjects such as archaeic medicine— the term is his— the late
Alexandrian school the history of epilepsy or problems of the relations
between philosophy and medicine There are few younger medical his
torians today who combine knowledge of medicine with such broad phiJ
ological, historical, and philosophical experience To the institute a ma**
of such caliber was indeed most valuable
Since Greek medicine was the foundation of western as well as of Aia
bic medicine an institute like ours was bound to place strong emphas*|
on classical studies and we needed a man to direct them He was foun
in Dr Ludwig Edelstem who came from the University of Berlin an
young as he was who had acquired considerable reputation throu^ 3
highly original book on the Hippocratic wntings ” He joined the sta m
1934 and until his departure in 1947 made the institute a very
center of study and instruction in classical medicine It was his exce e
idea to steer young classical pbiJoJogists into the held of ancient
through a program of fellowships, as a result of which two Carnegie

# I am most g:rateful to Dr Garrison for the help and advice he gave me prepa
tion of my book, on American Medicme Leipng I93S New York 1934

10 Zur Geschichte von Moral und Syphihs Arehiv fur Geschichle der Mr
348 1927 jgjg

II Der systematEsche Zusammenhang jm Cotpm Hippocratjcum Kyfifos I 9-

12 ricol und die Sammlung der Hippokratischen Schriften fro

schungen lur hlassuchen Philohgte no 4 Berlin 1931 About Dr Edelstem an
«ee this bulletin [Bulletin of the IruMute of the Hutory of Medicme} 2 200 I
of the History of Medicine} 21 558 194?

MEDICAL HISTORY IN THE UNITED STATES 243

lo^vships in Graeco-Roman science were created in 1941. Tliey brought
Dr. I. E. Drabkin and Dr. G. Raynor Thompson, two very promising
young classical scholan, to the institute. The fellowships would in all
probability have been continued had the svar not interfered.

Another former European student of mine svho joined the staff as Re-
search Fellosv, although very much later, tvas Dr. Erwin H. Ackerknecht.
The inaugural dissertation that he xvrote at the Leipzig Institute was a
brilliant study on the medical reform movement of IS48.” After special-
ized training in psychiatry he studied social anthropology and came to
us as a man equally well equipped in medicine, history, and ethnology,
a rare combination. He also branched out into the history and geography
of disease with a monograph on malaria in the upper Mississippi Valley
1760-1900, which attracted a great deal of attention,^*

My intention was by no means to run the department with Europeans
alone, but I needed a few of them to fill in gaps that I could not close
otherwise at that time, and I am glad to say that I was able to save and
to win for America some valuable European scholarship that tvould have
been engulfed in the cataclysm only a few years later. I svas very anxious
to have Americans on my staff. In the beginning I bad the cooperation
of Dr. Oliver and Dr. Garrison. It tvas a great joy to have Dr. Sanford V.
Larkeyjoin our group when in 1935 he succeeded Dr. Garrison as \VeIch
Librarian and Lecturer in the History of Medicine. A Doctor of Medi-
cine of the University of California, a Master of Arts of Oxford, a former
Fellow of the Huntington Library, he brought a great deal that we had
not in such measure, his knowledge of English history, of English litera-
ture, medicine, and science. With H. L. F. Lutz and C. D. Leake he had
collaborated on the translation and annotation of the Egyptian Papyrus
Heant, had worked on the English translation of Vesalius and on many
aspects of Elizabethan medicine.

It svas clear to me from the very beginning that an American institute
of the history of medicine must also cultivate the history of American
medicine. The first book I wrote in my new position was one on Ameri-
can medicine,” because I felt very strongly that I myself must be familiar
with its history. Miss Genevieve Miller became our specialist in the field,

*S“BeitrSgc mr Geschichte der Rfediiiiiattefonii von tBiS," Archiv fur Cesehickte der
lAedizin SSidl-HO. IIM83, 1952.

"Malaria in the Upper MissiMippI Valley, 1760-1900," lupplemenU to Bulletin cf the
History of Medicine, no. 4. BaUimore, 1945-
s* American Medicine, New Yort W. W. Norton. 1954.

244

ON THE HISTORY OF MEDICINE

who joined the institute first as a student, then as my research secretary,
and finally as a member of the staff Her books and papers are well
known her courses were much appreciated by students of all classes and
as a skillful editor of this bulletin she rendered invaluable services to the
institute as well as to the American Association of the History of Medi
cine

I ahvays felt that an institute of our type should cover the whole world
and I once had plans for creating branch institutes m China and India
countries where you can study ancient and medieval medicine in the
'‘^Id I soon realized, however, that such plans could never be put into
tice, but we did study the history of Chinese medicine Dr Edward
Hume joined our group as Lecturer m the History of Medicine m
i938 He brought to us his rich knowledge and the experience of a life
time in Chinese language and Chmese medicine and gave every year very
interesting seminars We also were fortunate m having a graduate stu
dent, Ilza Veith, who made the first translation into any Western Ian
guage of the Huang Tt Net Ching Su Wen, one of the earliest classics of
Chmese medicine

We had a good staff for many years, highly diversified Put together
we could handle texts m at least sixteen languages People often came to
offer their services as translators, but not once did anybody come who
knew a language that one of us did not know also

What IS the task of an institute? Why do we need them? Why w
not enough to appoint scholars and let them work wherever they please
First of all there is the very important question of continuity A scho
dies or retires, and his work ceases But where there is an organize
department a successor must be appointed, and the work is carried on
Thus an institute is a collection of specialized tools, books manuscrip
and printed, autographs, documents, portraits, pictures, medals,
objects, tools for research and instruction, which must be kept toge
and improved constantly With every year that passes an institute
comes a better tool But just as the best violm is dead unless
somebody to play it, an institute is lifeless unless there is a group o
to use the tools They may differ a great deal as individuals, but t icy
united by a common ideal of scholarship and are working togei le
wards a common goal

Collections are very important, but they are instruments not e
The primary purpose of a university department is the advance
knowledge through research and the instruction of students

MEDICAL HISTORY IN THE UNITED STATES 245

In its researches the institute endeavored to cover the whole field of
medical history. IVhat it achie\'ed and where it failed is illustrated best
by the bibliography published in this same number of the bulletin. A
new institute called for new means of publication. A journal was planned
by Dr. ^Velch from the very beginning. We launched it in 1933 very
cautiously as a supplement to the Johns Hopkins Hospital Bulletin, be-
came independent two years later, and joined forces with the American
Association of the History of Medicine in 1939. It was foreseen that the
institute, in addition to papers, would publish monographs and also texts
and documents. It stnick me, moreover, that many of the classics of
American medicine were extremely difficult to find. They had been used
up in the pioneer days. This called for a tliird series of books. The insti-
tute was also extremely fortunate in having a visiting lectureship created
by a generous grant of Dr. Emanuel Libman of Nesv York and named
in honor of the great Japanese investigator Hideyo Noguchi. I thought
that it would add to the dignity of the lectures if they were published in
book foiTO. And thus we suddenly had, in addition to the journal, four
series of books. Looking back today, after having been an acting librarian
for three years, I think that, if I bad to launch our publication program
over again, I would not start out with four series but would have all our
books in one series, which would be much easier to handle.

The history of medicine is both history and medicine. It is one aspect
of the history of civilization and part of tlie theory of medicine. The his-
torical analysis is a method that can be applied profitably in medicine,
as in other fields, to clarify concepts, to make trends and des’elopments
conscious so that we may face them openly and may act more intelli-
gently. ^Vhen you pursue your historical studies into the present, you
imperceptibly enter the field of sociology and begin to see that an infi-
nite number of nonscientific factors, social, economic, political, philo-
sophical, religious, may rvell delenninc success or failure of medicine,
factors which must be investigated.

History makes a solid foundation for such studies, and I had plans for
developing the institute in such a rvay that it would have consisted of
two divisions, one of the history of medicine and one of the sociology
and economics of medicine. The amount of money required for such an
extension was not large. No construction was needed and tlie Welch li-
brary was rich in books on the subject and could easily have acquired
some more material. What was needed besides some equipment ^vas sev-
eral staff members, and just at that time some excellent men were avail-

246 ON THE HISTORY OF MEDICINE

able whom I would have preferred to tee !n the academic atmosphere
rather than in government offices But it was impossible to hnd me
money, not only on account of the depression but chiefly because the su
ject svas one that might easily yield controversial results
' Although sve could not create a special division for the soe ^
economics of medicine, the subject svas not entirely “S
stitute because I was vitally interested in it
numerous papers were devoted to it, and as early as

of our Dean I began to give courses in it

This brings me to the teaching program of it

we devoted much time and much thought I shall be ''ery ^

because I have discussed it at some length m a previous p p
joined the university. Dr Wclcli had retired ™ small

of a few lectures and conferences given by the
staff then existing, so that we practically had to begin f
experimented a great deal, and I am glad to say that to the presen^ J
we never stopped experimenting The goal | teaching the

ences and humanities into the medical school We <lid it hy S
history and sociology of medicine on various 'evels Fo y y
department gave an introductory course to premedical
College of Arts and Sciences until the authorities of the S ^
to be interested in it A lecture eourse on 8'“”' ™edtca liisto^^
given every year to the entering class of the medica s ii ■ medicine
supplemented by an annual course in the history of Ame
We then gave a senes of seminars on a variety of specia jj^^jents”
jects which were attended by groups of from six to twen y
It was felt that, in a school that had an organized depar m
history students who had a special interest in the field mu ^^^lojogy

opportunity to enter more deeply into it The courses ' medi

and economics of medicine were addressed primarily w jectutc

cal students and to students of the School of Hygiene lecture

or, more frequently, seminar courses, or sometimes an e em ^
course was offered and at the same time an advanced inter

her of years we were the only department in the universi y

the Crossroads

18 The Soaal Saences m ihe Medical School in The University a

us“c ol .hew enucu vp b, hwmg .he

ta- .he .uhjee. .he, had ..ud.ed See d.u tallenn [CelW.e •/ ■'.«
e/ MedmeeJ 1 193 256 1933 2 447 476 1934 2 639 696 1935

MEDICAL HISTORY IN THE UNITED STATES 247

ested in this field, but today the School of Medicine has a Department of
Preventive Medicine and the School of Hygiene offers instruction in the
administration of medical care, so that the institute may have to revise
its program or will have to coordinate it more closely with that of other
departments.

And otherwise our plan of instniction endeavored to fill in gaps wher-
ever we found them and to satisfy needs when they became articulate.
Courses were given to first year medical students in Greek and Latin
terminology. IVhen during the war there was among the students a great
demand for general orientation, sve gave every year a course on the his-
torical foundations of the present world conflict. When more and more
students asked for instruction in philosophy, the department offered
courses in philosophy. IE students wanted to learn Greek, which hap-
pened more than once, we taught them Greek. We could do it because
we had a highly diversified staff, and I think that an institute like ours is
particularly important in a medical school which is located so far from
the academic division of the university that students cannot attend
counes of otlier schools. The courses have to be brought to them. All
in all we offered every year from twelve to fifteen courses.

It is only fair to say that we served not only the university but the
whole country. The number of manuscripts we read, of queries we an-
swered, of visitors we advised, of lectures we gave every year out of town
was very large indeed, and three times we gave postgraduate courses,
graduate iveeks, during which all the resources of the institute were mo-
bilized and placed at the disposal of the participants.

And now let us look for a moment into the future. When Cordell in
1904 made his survey he found that only seven of the schools reviewed
offered courses in medical history. A new survey was made in 1937 by
the American Association of the History of Medicine,^® which revealed
that fifty-four medical schools, or seventy per cent, offered courses in the
history of medicine. It is very likely that many of these courses were be-
low the general standard of instruction of the various schools and that
they were not given by men actively engaged in research in the field.
Nevertheless, the mere fact that fifty-four schools considered medical his-
tory important enough to be taught to students showed that interest in

18 £ut/etin of the History of Medicine 7:627-662, 1939.

248

ON THE HISTORY OF MEDICINE

the subject had grovm considerably in this country m the course of one
generation Forty one schools, moreover, reported that they had library
facilities for research in the field

The American Association of the History of Medicine has grmvn from
year to year, and, although its membership is not very large considering
the enormous number of physicians and other medical personnel in the
country, it is flourishing and active, has annual meetings with very stimu
lating programs, and has become a truly national organization which
includes all individuals active or interested in medical history, and it a!io
acts as a federation of local societies It is ruled most democratically by a
council which consists of the delegates of the constituent societies and
elected officers It is easy to foresee that the association ivill exert a grow
mg influence m the country

I have often been ashed two questions that seemed embarrassing but
actually were very easy to answer Why did I not tram more young
people as medical historians? The answer was that, first of all, it was very
difficult to find die right sort of young people, physicians trained m the
humanities with an understanding of history And, second, I could not
encourage young people to devote many years of study to a field m which
there were no openings There were no paid positions outside of Ba!t*
more at chat time And this leads to the second question

Why was the example that the Johns Hopkins University set by creat
mg such an institute not followed by other institutions? The answer to
this question was also e\ident The Institute was opened on October
1929 Six days later the stock exchange collapsed in New York, and lus
marked the beginning of the great economic cnsis which was to shake t e
world The entire history of the institute so far has fallen into the
of depression, ivar, and postwar confusion Whoever ivants to appnn^^
my work should keep tins m mind We bad extraordinarily difficult
when we did not know how to carry on and some very promising an
timely projects could not even be considered for lack of funds Duri S
those yeais, no other university could possibly have created a new dcp
ment of the history of medicine

Times have changed, and today we see the beginnings of an ac i
that may develop considerably m the years to come The Umver^ty ^
■Wisconsin has created a full chair of the history of medicine, ^
a great satishction that one of our former co workers, Envin H
knecht, has been appointed to u But the University of 'Wisconsin
more It establislied two associate professorships of the history o

MEDICAL HISTORY IN THE UNITED STATES 249

and. with the American Institute of the History of Pharmacy and the im-
portant collections of books it recently purchased, it may develop into
a great center of studies in the field.

Yale University has the equipment for a first-rate institute with the
rich collections of Harvey Cushing, Arnold C. Klebs, John F. Fulton,
E. C. Streeter, and some others, and there is no doubt that a chair will
be created some day soon. Very good collections are available in a num-
ber of other universities— Kansas, Stanford, California— and in New York,
Boston, Philadelphia, Washington, such splendid collections of medical
history are available that universities desirous of founding a department
of medical history would not have to spend their funds purchasing rare
old books but could use them for a staff and for basic reference books.

It seems important to me that in making plans for the future one
should avoid creating departments merely on paper. A department or
institute of the history of medicine is one in fact only if it has a budget
and a staff, and the professor and his associates should have adequate sal-
aries so that they would not have to make a living in some other occupa-
tion. Not every medical school can afford a department at the moment,
but some should be developed in various sections of the country, particu-
larly where resources in books and other materials are already available.

There is today a very strong and very genuine interest in the history
of science. Recent events have stirred up many people and made them
wish to see science in the proper penpectivc and ^vith its social implica-
tions. President Conant's Terry Lectures, moreover, pointed to the
historical presentation as one that was highly suitable to give college stu-
dents an understanding of science.’* In the last few months I had in-
quiries from at least half a dozen colleges which were looking for scien-
tists ^vho could teach the history of science. Ne^v chairs have been created
not only at Wisconsin. Cornell University enriched its Department of
History by appointing a brilliant young roan, Henry Gueriac, as profes-
sor of the history of science.

The history of medicine and the history of science, different as they
are, have so much of their past in common and use the same tools to such
an extent that departments could easily be combined wheres-er the medi-
cal school is not too distant from its mother university.

Another very significant development was that general historians be-
came increasingly interested in the history of medicine and science.
Richard Shiyock and his school at the University of Pennsyh-ania have
** James B. Conaot, On Understanding Science, New Haven. I W7.

250

ON THE HISTORY OF MEDICINE

acquired an international reputauon, and a number o£ his students ha^c
made and are making important contributions to the subject The late
Carl L Becker of Cornell in his splendid textbook. Modern Htslory, the
Rtse of a Democratic, Scientific and Industrialized Civilization has shoivn
that he was fully aware of the part played by science in the shaping ol
our modem world and has even expressed it in the title of his book n
the field of medieval medicine and science, the historian Lynn Thom
dike and his school at Columbia University have published numerous
texts reference books, and studies of greatest value, and at the Uni'crstt)
of North Carolina Loren C MacKinney is very active in the same field

And so you see that we may look into the future with great confi cn«
—and that I can afford to retire from the scene in order to devote my u
ture efforts entirely to research and to the vmtmg of a feiv books t at
have been preparing for many years and that I could not possibly ivntc m
my present position

Now that I have to say good bye to you, I feel very sad because ma^^
of you have been infinitely more than students, have been real *
me, but I know that the ocean cannot separate us and that we sha
in close touch I have been talking about medical history in the m
Slates and I am going to live m a small village of Switzerland But t ^
continue to feel as an American medical historian because I will con « ^ ^
to ivrite in English and to publish my works m this country An s ^
want you to think of me not as a foreigner but as an American sc
who happens to be working abroad

I am leaving a good institute behind, one which still has

bilities of development A new and younger man will take over wit

plans and new ideas, and this is as it should be I am not going to q ^
Osier, but I really feel that no one should stay too long in t e
position

To the Johns Hopkins University, which has been very good
to which I have devoted fifteen of the best years of my hfe, I s
remain deeply attached, and I shall never forget the Johns
Medical History Club

UNIVERSITY EDUCATION

-«S/5

Chairman of the Council, Mr. Principal, ladies and gentle-
men:

I am deeply moved, and I wish to express my profound gratitude for
the great honor bestowed upon me by the University of the Witwaters-
rand. Sometimes I feel that honorary degrees are somewhat like arterio-
sclerosis, a symptom of the beginning of old age. You have worked assidu-
ously for a long time. You are getting on in years. Your arteries begin to
harden and your work to be recognized. But then, of course, there is a
great difference, in that arteriosclerosis is a most unpleasant symptom—
of which I have been spared so far— while the recognition of a man’s work
is the strongest encouragement he can possibly find and the most power-
ful incentive to pursue in his endeavors. And for an academic teacher
there is no higher distinction than to be admitted among the honorary
graduates of a univenity.

In honoring me you have at the same time expressed your appreciation
of the field of research to which I have devoted my life’s work. And since
it is unusual for a ph^'sician to study the history and sociology of medi-
cine. let me tell you how I became interested in the subject and let me
pay tribute to the memorj’ of some great teachers it tv’as my good fortune
to have. If I have been able to make a contribution to my field of studies—
modest as it may be— it was due to hard work, without which nothing is

An address delivered at Sclbome Hall In Johannesburg {South Afrita] on November 15,
1939, on the occasion of the conference of the de g ree of Doctor of Literature hanorii cauia
by the Unnersity of the Witwatenrand.

252

ON THE HISTORY OF MEDICINE

ever achieved, but also and to a large extent to the inspiration I received
from great teachers.

I have to go far back to recall the figure of the first teacher ^vho had a
profound influence on the formation of my mind. "When in 1901 iny
family moved from Paris to Zurich, in Switzerland, I was ten years old,
and since I had a very imperfect knowledge of German I was sent
a public but to a private school. It rvas owned and directed by an u
cator of genius, Fritz von Beust. Son of a German revolutionary w o
after 1848 had sought asylum in Zurich and opened a progressive schoo .
he followed in the footsteps of his father. A strong man with a pin ' ace
and white beard, he was a convinced socialist and atheist and was rsi o
all an enthusiastic scientist. Science played a dominating part m t ®
curriculum. The rotation of the earth was demonstrated to the c u ten
by having them build a sundial in the garden and watching it throug
the seasons. We learned geometry by making cubes, cones, and ot cf
bodies. In geography we pasted maps on cardboard, dissected the
altitude layen with the jigsaw, and mounted them so as to construct re i
maps of the country. And every few weeks we made whole-day
into the beautiful surroundings of Zurich. The geography of the
was discussed, but the chief purpose was to collect plants. Each one o
had a herbarium, and at the age of twelve wc had learned to ana yie^
structure of plants and were able to diagnose the family of °
them. A most liberal spirit pervaded the school. Teachers and stu
were carried away by von Beust's personality, whose mere
sufTicient to ensure discipline. He opened up for me the realm o na^
and awakened in me, as in so many others, a deep interest m sci
was only much later that I realized how much the three years spen
that school had influenced my whole outlook. After von Beust s
school w’as continued for a fesv years by his co-w’orkers, but t ic ^
spirit was gone and the school closed dovm. It could afford to o
cause in the meantime the public schools had adopted most o •

. t -as a pub-

In 1901 1 became a student of the Cymnoitum in Zurich. It jjj,dics.
lie school prcp.aring boys from all classes of society for academic s^^

I svas in the humanistic division, svhcrc for six and a half a

eight hours of l.alin and for five and a half years eight ° j-j, jnd
week, so that at ilic end of the course most of us could rca
some of us also Greek fluently. In spite ot the emphasis ^ all
modem langtiagcs were not neglected French svas a require

UNIVERSITY EDUCATION

253

through the course, and we had a choice between English and Italian. In
addition we had excellent instruction in science, n-hich proves that it is
quite possible to combine science with humanistic studies.

Among the many teachers I had during that period one stands out far
above all the others: our professor of history, Otto Markrvart. He rvas
not a detached but a passionate historian, violent in his sympathies and
antipathies. He worshipped Mozart and loathed Wagner. A student of
Jakob Burckhardt, he was a humanist, deeply attached to luly where
he spent his vacation every year, returning with piles of photographs that
he passed around in the classes. An enthusiastic teacher, he could electrify
the students. Discussing a stormy session of the Roman Senate, he jumped
up, addressing the class: ‘'You are the Roman Senate. What are you going
to do? You have defeated Carthage but again she raises her head threaten-
ingly. You there in the comer are Cato. Get up and tell them what they
shall do!" And the boy, Cato himself, addressed the senate passionately,
ending his harangue with the ominous “Cetemm censeo, . .

From Markwart I learned svbat history is-noi a dead subject but a
living force that determines our life. He taught us to think in terms of
historic forces and developments. And in his broad approach to liistory
that embraced all aspects of civilization he passed on to u$ bo^-s the teach-
ings of his master Jakob Burckhardt, whose classical books we dn’oured.

The old Gymnasium in Zurich was a great school to which I owe in-
finitely more than I was aware at the time. It had a great tradition of
liberalism, and all philosophies were represented among the faculty. It
taught us how to organize our work and succeeded in challenging us and
arousing our intellectual curiosity so that sve could spend whole nights
discussing Plato, Kant, Darsvin, Haeckel, or Marx, and sometimes almost
came to fist fights over problems of Russian literature or modem art.
Wien we graduated at the age of eighteen or nineteen we were well
prepared for the imis'ersity.

During my Gymnasium days I became interested in (he East, and since
the language is the key to the undersunding of every civilization I began
learning Arabic. For a number of years I spent an early hour on the study
of Arabic every morning before going to school. I then look the Hebrew
courses that were olFercd at the Gymnasium to those students svho in-
tended to study theology. After graduation I registered in the Philosophi-
cal Faculty of the University of Zurich as a student of oriental plnloIog>’.

I continued my studies of Arabic and Hebrew and took up Sanskrit. And
since the latter course proceeded rather slowly I worked sviih a priwie

254

ON THE HISTORY OF MEDICINE

tutor, and at the end of the year we were reading the Panchatantra and
similar texts

In those days the University of Zurich was rather weak in oriental
studies, and this determined me to spend most of the year 1911 in Lon
don I had some excellent courses at University College, and since I ivas
the only student attending them learned a great deal With Mabel Bode
I read the Meghaduta and with H Hirschfeld the Fakhri and the Dt
lectus Veterum Carmtniim Arabtcorum of Noeldeke At the same time I
began the study of Chinese at King’s College and devoted a great deal of
time to It My teachers Were rather skeptical and repeatedly pointed out
to me that it was impossible to embrace the whole Orient, that I would
have to specialize either on the near East, on India, or on the far East But
I refused to specialize I was interested in the East as a whole, in compara
tive religion and comparative literature, in the migration and transmis
sion of literary subjects and similar problems And since I was very young
I thought that nothing would be impossible to me

I worked very hard in those years and always had some grammar in my
pocket and a notebook full of Chinese ideograms But the time came
when I had to admit that my teachers were right It could not be done
The task became so big that quite physically I could not master it But
still refused to specialize, and since I had always been greatly interested m
saence I went back to the University of Zurich and took the science
courses that were given to students of science as well as to medical stu
dents

There again, it was my good fortune to have a great teacher, the Pro
fessor of Zoology and Comparative Anatomy, Arnold Lang He was
former student of Haeckel a great expert in zoology of the inverte ra ^
and in genetics His lectures were entrancing, and we never
single one During a course he never attempted to cover the whole
but discussed only a few selected subjects a few animal forms elem
of genetics, or similar topics These he presented in great detail, giv'
the history of the problem and discussing general principles
with It He could spend weeks developing the structure of one
drawing it in colored chalks on the blackboard And when at ong^
he had given the finishing touch his bearded face brightened up ^
felt like God after the creation of the world He had reaeated the
or the fish under our very eyes And having ivatched this creative
we could never forget it We had been allowed a glimpse into t e w
shop of nature

UNIVERSITY EDUCATION

255

At the end o£ the course he apologized for having covered so little
ground but added that we could easily find the rest in books, and that
if we had followed him we would be able to consult and use books intel-
ligently. I never had an opportunity to talk to Professor Lang. He did
not know of my existence. I was just one of hundreds of students rvho
crowded his lecture hall. But I svas tremendously influenced by him be-
cause I had the privilege of svatching the working of his mind. And from
him I learned hov/ to teach. Much later, when I became an academic
teacher myself, I remembered how he had presented his subject, built up
his lectures, and organized his courses. Tbe European university has a
great tradition of academic oratory, an art that is not taught in courses
but passed on from master to student through example and by the mere
force of personality.

My year in science tvas a happy one and for a ^vhile I considered re-
maining in science, but again the phantom of specialization arose- What
was it to be: chemistry or zoology or botany? Medicine seemed the
broadest field, and so I became a medical student and never regretted it.
Medicine undoubtedly is one of the most fascinating academic subjects
in that it leads the student through heights and depths of human life.

I studied medicine at the University of Zurich, where I graduated in
1917, and at the University of Munich, where I spent the summer of
1914. 1 had many excellent teachers during the six years of my medical
course, but two of them stand out far above all others: Friedrich von
Muller and Ferdinand Sauerbruch. They ^vere very different but great
teachers both.

Friedrich von Muller Avas at the height of his career tvhen I took his
course. He svas Professor of Clinical Medicine in Munich, a dignified
personality and a great physician and scientist with vast cultural back-
ground. He represented the best type of German professor. His task was
to introduce the young student into the field of clinical medicine. Every
morning he gave a clinic of two hours at which he presented one typical
case. Four students were called upon, and rvith them he examined the
patient and discussed the case, while the others svatched them with
breathless attention. His presentation invariably began with the ques-
tion: ‘“What do you see, svhat strikes you when you look at the patient?"
whereby he meant to develop our faculty of observation. He repeated
over and over again that medicine rvas not difficult provided we had a
thorough foundation in anatomy, physiology, and general pathology.
"You must know the structure of the human body, its function and the

256

ON THE HISTORY OF MEDICINE

mechanisms available to the organism to react against lesions The rest
boils down to observation and correct reasoning ” And this was what we
learned from him first of all to observe phenomena and to reason cor
rectly I followed his precepts all through my studies, and it saved me a
lot of trouble Von Muller s teaching was so impressive that to the present
day I remember every individual case he presented during the course
and even remember tlie face of many of the patients The classroom was
croivded with hundreds of students, and a regular race for seats took

place every morning

Sauerbruch was an entirely different personality He came from Mar
burg to Zurich m 191 1 as Professor of Surgery He was young, cnthusi^
tic, and temperamental Students loved him or hated him, but nobody
who ever came m touch with him remained indifferent He ivas an in

tuitive type of man a bnlhant surgeon who in his surgery as well as in
his researches showed a great deal of imagination and originality Hu
clinic was inspiring and spectacular Once, desiring to impress upon us
the importance of the early operation of appendicitis, he demonstrate
over twenty cases m one clinic, some of whom had been sent in for opera
tion too late Bed after bed was rolled in The professor hardly said a
word, but the difference between the patients was striking All those w o
had been operated on early looked flourishing, while the others loo c
very sick It was a piece of showmanship, but nobody ever forgot
lesson Sauerbruch taught us infinitely more than surgery He made u
think— think m terms of biology A student could pass an examination
with him without knowing many facts provided he was able to approa
a case intelligently and to think properly In his early years in Zun
Sauerbruch gave a course m general surgery that was attended by s

dents of all classes by the faculty, and by the practitioners

One had to be there an hour m advance to secure a seat Evi
lecture was a masterpiece, well rounded, full of original ideas

Every single

lenging thoughts It was certainly not by accident mat •

Muller and all great medical teachers I ever had, was deeply
m the history of medicine and never missed an opportunity to
histoncal remarks Men who made history were alu'ays aware of deve
ments m which they were taking part I was Sauerbruch’s stu
three years and came closer to him than to most of my medical teac
He took a genuine interest in young people and kept an open noi
which students were alu’ays welcomed During the war he took a gro

us on a most instructive tour through German military hospi

that Sauerbruch, hie

UNIVERSITY EDUCATION

257

later, in Germany, he helped me in my career whenever he had an oppor-
tunity. Sauerbruch s teachings and personality had a profound influence
upon my o%vn development, and I shall remain attached to him all my
life.

1 tvas an enthusiastic medical student, but I obviously remained in-
terested in the humanities. In Zurich, medical school and university were
on the same campus so that it was possible for medical students to attend
courses in the academic division, which I frequently did. In Munich,
once in the middle of the academic year I suddenly felt tired of the
hospital and of medicine at large. I be^n skipping classes and spent the
days in museums and art galicries, the nights in theatres and concert
halls. I was in a turmoil, and when quite accidentally I met a friend in
the street who tvas leaving the same day for Venice I decided to join him
and spent several weeks in Italy. For a while, medicine was entirely for-
gotten and I lived in a world of history and art. Then, one evening,
sitting in a caK of the Piazza San Marco I felt an irresistible longing for
the hospital, and there for the first time it occurred to me that medical
history and the history of science might be a field in which I could com-
bine all my interests. I went back to Munich the same night in a state
of great elation. The next morning I resumed my hospital work with
enthusiasm. In the afternoon I went to the library where I found Isis, the
journal recently launched by George Sarton, and the various publications
of Karl Sudhoff. In the next few days I made a plan to study the various
periods of the history of medicine and science by reading the most im-
portant texts. A German publisher ^vas issuing a series of historical source
books that included the history of science, and I soon svas collecting
materials for a history of oxidation. But then the war broke out. We
were all called for practical work, and the book \vas never finished.

Here I must recall one school that taught me probably just as much
as the university, although I was not fully aware of it at the time: the
army. I served for nearly two years in the Medical Corps of the Swiss
Army. In Switzerland every citizen is trained to be a soldier, and medical
students are automatically enlisted in the Medical Corps at the age of
twenty, where they are promoted to higher rank according to their pro-
fessional status and length of service. At the outbreak of the World War,
the entire army was mobilized and kept under arms for the first eight
months. After that time, when it became apparent that the country rvas
not immediately threatened, only one half of the army rvas kept at the
borders, so that throughout the Avar we medical men spent half of the

258

ON THE HISTORY OF MEDICINE

year in army service while we could ointinue our civilian work dunng
the other half

The two years in the army were a valuable experience to me in many
respects Medically I learned a great deal We were often stationed in
far remote mountain valleys where we had to attend the civilian popula
tion as well as the troops, sometimes under very difficult conditions
Much of the work was practical public health work in which I became
greatly interested The Medical Officers’ Training School gave excellent
instruction not only in war surgery but particularly in public health In
1918 I had the good luck of being one of the first in my division to be
stricken with influenza so that I was fit again when many of my fellow
medical officers ivere sick I spent most of the year treating influenza
patients in a variety of troops and regions and worked for several months
in the Influenza Bureau of the Surgeon General s office, from which I
was sent out to make epidemiological surveys all over the country

But the army was a great school to me in other respects as well So far
I had lived the life of the middle class and had moved mostly in academic
circles 1 was interested in social problems but looked at them more from
the theoretical and public health angle In the army I came in close
touch with the working class In the cavalry, to which I was attached for
over a year, the soldiers were peasants, in the artillery, to which I was
transferred later, they were factory workers, most of whom I'cre cm
ployed m scNeral large metallurgical plants m the vicinity of Zunen
These anonymous soldien became my teachers They opened xny c)^
about many problems that I had not seen before and made me rcalne
how little I knew about the world in which I was living They made me
Msualize a field of research and activity equally important to the his-
torian as to the medical man They had confidence m me and on many
evenings I went to the sickroom under the pretext of a late ward roun
sat on a bed and listened They discussed their own problems and h
cussed the war And it often struck me how much more convincing t c
interpretations were than those I heard m the officers’ mess
neutral but surrounded by warfanng countries, was an ideal post m ^
which to observe events Information was obtainable from all sides a

It w-as much easier to get at the truth than m those counines

where uni

literal heavy propaganda obstructed the vision The impcriahsti'^ c la
acter of the war soon became apparent and it was not difficult to rca
the full significance of tlie Russian Revolution . j

The armistice was signed and the war was over, at least nomina y

UNIVERSITY EDUCATION

259

was twenty-seven years old. I had an all-round medical training and had
acquired some practical experience in medicine and public health. Dur-
ing the inteiv'al between two service periods I had interned for a u'hile
in obstetrics, and in my senior medical year I had done experimental
research in the Pharmacological Institute of the University of Zurich
under Professor Cloetta, as the result of which I had published my in-
augural dissertation under the title “Experimental Investigations on the
Effect of Chronic Camphor Medication on the Normal and Sick Heart,"
And now the question arose what the next step would be?

I knew what I svanted and felt no hesitation about it. My field of re-
search was to be medical history. To most of my former professors I was a
lost sheep, “^^edical history,’* they said, “is a delightful hobby for retired
practitioners but there is no career in it." I was no longer a child and
knew better. And this time I was right. In all my previous studies I had
felt the need for an historical approach to any given problem. I saw that
general history must by necessity remain fragmentary and lead to wrong
interpretations if it does not include the history of science. And I felt,
although rather vaguely at the time, that medical history studied in a
broader sense could be developed into a method that could contribute to
the solution of urgent social problems of medicine. In medical history I
found a field that was not a narrow specialty and in which 1 could com-
bine my various interests. I was fully aware that I was not yet equipped
for such studies and that I would have to go back to school for at least
three years- And since I could no longer afford to make a tvrong start I
went to Leipzig in 1919, as soon as conditions permitted, in order to
consult and work with Karl Sudhoff.

The Institute of the History of Medicine founded in 1905 at the Uni-
versity of Leipzig was at the time'the undisputed center of research in
medical history. The institute was Kari Sudhoff. He filled it with his
powerful personality. It was his workshop that he had built up. He had
no associates and no secretary and was only aided by an “Institutsdiener,"
who served him devotedly and kept the place in order. But he had a lai^e
group of students who wrote their inaugural dissertations under his
guidance and published for him the texts in which he svas interested.
And every researcher in medical history from all over the world came to
Leipzig to consult him and to use the resources of the institute.

He was an indefatigable worker. From 1905 on, when he abandoned
general practice and accepted the chair in Leipzig, he published a large
number of monographs, hundreds of papers, and edited half a dozen jour-

260

ON THE HISTORY OF MEDICINE

nals and serial publications His bibliography shows that in certain yean
he published over forty papers— mostly medieval medical texts that he
had discovered in his annual peregrinations He was a poor lecturer i^as
restless in his thinking so that he could jump abruptly from one subject
to another without finishing his sentences The lectures, therefore, were
rather confused, and it was hard to follow him He exerted his tremen
dous influence not through teaching but through his imtmgs and per
sonal contacts He had a kindly nature and could be very jovial, but he
could also flare up and in such moments he looked like Jupiter tonans
His eyes sparkled, and his voice was thunder A dominating and donu
neermg personality, he could not tolerate to have anybody beside hini
and colleagues who did not accept his leadership were excommunicated
pitilessly

He was different to me He was infinitely more than a teacher, ivas lAc
a father to me My first visit in 1919 was the beginning of a very close
association that lasted for many years From 1919 to 1925, whether m
Leipzig or m Zurich I was in constant touch with Sudhoff He supplied
me with books, photostats, and photographs from the institute collcctiom
and helped me in any possible way I had the privilege to assist him m
reading and correcting galley proofs of several of his books, and we met
every year at the annual meetings of the German Society of the History of
Science, Medicine and Technology From 1 925, when I succeeded him
the chair at Leipzig, to 1 932. when I left for America we met almost daily
and there was not a thing on earth that we did not discuss In 1933 I
awarded the Karl Sudhoff Medal, and on the occasion he svrote in loo?
hand an appreciation of my work that I treasure more than anything
else After that time, to my deep sorrow, our close relationship gradua y
came to an end Karl Sudhoff had joined tlie National Socialist Party |
was a profound shock to me, and for a long time I could not understand
how he, a staunch liberal and rationalist all his life, could at the ag® ®
eighty become a Nazi and identify himself with Hitlers doings I ha>«
only one explanation for it that he ivas driven by his fanatic patriotism
He deeply felt and resented the humiliation of Germany after VersaiU«
and like so many others must have honestly believed that Hitler woo
be the savior of his country

Karl Sudhoff died m 1938 He was the great pioneer m
tory, who not only advanced the subject by leaps and bounds through
researches but also organized it and gave it a definite place m the rac >
curriculum The Leipzig Institute rvas the first research institute c'

UNIVERSITY EDUCATION

261

establuhed in the field. It set a high standard of scholarship and served as
an example tliat svas soon to be followed by other universities in Ger-
many and abroad. It was my good fortune that I could begin my career
in such an institute and with such a teacher. It gave me a solid philologi-
cal foundation without which serious studies are just as impossible in
medical history as in any other historical discipline.

In 1921, at the age of thirty, I felt sufficiently prepared to apply for an
academic position. I tvas appointed Privatdozent at the University of
Zurich, where I had a small but devoted group of students. When Sud-
hoff retired in 1925, his chair and the directorship of the Leipzig Insti-
tute were offered to me. It was not an easy job to be the successor of such
a great man. I realized that the task was not to imitate my predecessor but
to preserv’e the high standard of the institute while develoning it along
my own lines. Sudhoff was primarily interested in the philological side of
medical history in texts and documents that he published by the hun-
dreds. 1 had become increasingly interested in the sociological approach
to history and in the sociology of medicine. I saw that the application of
medical knowledge to society was made so difficult by a variety of social,
economic, political, religious, and philosophic factors that had to be
investigated if progress tvas to be achieved. Without neglecting philolog-
ical studies I endeavored to develop the institute more and more along
the sociological line. My book Man and Medicine written in those years
reflects this attitude.

It was in 1927 that I first came in touch tvith William H. Welch. He
had done more for the development of scientific medicine in America
than anybody else, and now, nearing the end of his career, he intended
to establish at the Johns Hopkins University in Baltimore, with .which
he had been connected since 1884, an institute of the history of medicine
similar to that in Leipzig. He was traveling in Europe, purchasing books
for the new institute, and came to Leipzig to discuss his plans with Karl
Sudhoff. I was in touch with Dr. Welch from 1927 to the time of his
death in 1934, and although I cannot claim him as one of my teachers I
learned a great deal from him, as everybody did svho had the good for-
tune to be dose to him. As a matter of fact, I svished I had learned more
from him, particularly his unaggressive tvay of attaining an end by diplo-
matic means. Temperaments, however, are different.

The Johns Hopkins Institute svas opened in 1929. Sudhoff went to
America for the occasion. Two years later, in 1931, 1 was invited as visit-
ing lecturer. I spent two months at the institute, ^vhereupon I went on a

262

ON THE HISTORY OF MEDICINE

long lecture tour through all sections of the United States And while I
was traveling I was offered Dr Welch's chair

I was tremendously impressed by the United States I found democntic
institutions dear to me and found the country utterly different from
what It IS usually pictured by European travelers who see only the fapdc
and the material aspect of American life I was particularly impressed
by the universities, by their earnest desire to raise standards of scholar
ship and to carry on the torch of learning I found them fully aivare of
their great responsibility at a time when European institutions svere

breaking down under political and financial pressure Great interest iv’as
shown all over the country in medical history, the importance of svhich
had been emphasized by all medical leaders And I found urgent social
problems of medicine eagerly discussed by all groups involved The Com
mittee on the Costs of Medical Care was at the peak of its activities What
appealed to me particularly was the dynamism of America and its bra'C
experiment'll spirit, so utterly different from the stifling self satisfaction

and fossilizing feeling of superiority so often met with in Europe
In Germany things were developing from bad to worse, and it
apparent that the days of academic freedom were counted It was not
difficult, therefore, to come to a decision Once more I was successor to*
great man, in one of the worlds great medical schools, in a university
justly famous for its scholarship and liberal spirit 1 was in charge o a
young institute, inayoungand vast country— and I have enjoyed working

in America ever since I first landed in the new world

Ladies and gentlemen I apologize for this lengthy personal history in
address devoted to the subject of university education But instea ^
discussing the topic in a purely theoretical way I preferred to gi'C ynn^
practical demonstiaiion m evoking the figures of some men who
great academic teachers and in discussing factors that contribute
success of university education Let nie add a few remarks

^Vhen I look back at my early univenity life, it occurs to me **'^j*^^
a career would be rather diOicnlt in America as well as m South
Our students are so well protected, are guided and advised so we
they have hardly a chance to make mistakes Much thinking is
them, and they hardly have an opportunity to find dungs out for

UNIVERSITY EDUCATION 263

selves. I made endless mistakes, but I learned through them and found
my o^vn rvay.

I have a particular grudge against textbooks, the only literature ever
consulted by many students. Instead of reading Plato or Newton the
student reads about them and thinks that he knows them if he is able
to repeat a few judgments read in a book. The textbooks present a sub-
ject carefully digested and in a simplified tvay. They read without effort
and are forgotten over night. Do not misunderstand me. There are excel-
lent textbooks, and when used judiciously they have an important func-
tion to fulfill. They allow a rapid orientation over a wide field. But they
can never replace the study of original texts.

\Vhen a publisher wishes to recommend a book, he advertises it as
being "highly readable." He may even add that it is written in a "de-
lightfully informal ■way." And when a reviewer wants to praise a book
very highly he emphasizes its readability, by which he means that every
fool can read it without effort. And yet we all know that the books that
contribute most to the formation of our minds, the books that have made
history, are anything but "highly readable." They are books svith which
we struggle, that we read and reread with pencil in hand, books that we
have to conquer page by page. But once ive have conquered them sve
possess them. Many subjects are difficult by nature, and a presentation
ceases to be true svhen it is oversimplified. No knowledge can be obtained
without labor, and sve should not be afraid to require great efforts from
our students.

The goivn that we are wearing tonight is a medies’al costume, and this
reminds us that the Western university has a long tradition and a great
past. From the medieval university we have inherited many external
forms, such as the organization in faculties, examinations, degrees, and
also the main forms of teaching: /ecfio and disputatio.

In the lectio, the medieval professor read and interpreted a book and
the students ■wrote dosvn what they heard. Books were rare and expensive
in those days, and the books the students svrote during the courses be-
came the main body of their libraries. Conditions have changed since
then. Printing has made books easily available and has reduced their
price considerably. The function of the lecture, therefore, no longer is
to dictate books. The student can buy them for little money. The lecture
must give what the student will not so easily find in books, namely, the
living personal contact between man and man. In the lecture the pro-
fessor, an expert in his field, thinks aloud and develops his own views

264

ON THE HISTORY OF MEDICINE

on a subject He has an ideal opportunity to stimulate the student, to
arouse his curiosity, or to challenge him, in other words, to make him
think

We can study a symphony at home from the score and phonograph
records, but this does not make concerts superfluous In a concert ive
hear the interpretation of a s)’mphony by a definite conductor, and there
IS that magnetic contact between orchestra and audience that is so hard
to define The concert, moreover, inspires us and stimulates us to study
music of which ive had not thought before
As a student I had a simple method which I found very helpful IVhen
I knew what the subject of a lecture or a clinic would be, I read about
It before so as to have a certain preparation During the lecture I made
a few notes, as few as possible, just enough to be able to reconstruct the
lecture Students who ivrite much do not listen And then in the evening
I consulted a number of books on the subject and wrote a summary of
what I had read and heard, made notes about my personal impressions
and doubts, and marked points that would require further study I did it
on loose leaves so as to be able to add to it on later occasions
In the medieval disputatio, professor and students discussed a subject
weighing the pros and cons of an argument The corresponding modem
form of teaching is the seminary course that was so strongly developed
by the German university Here the students take an active part present
ing papers, reporting on studies made, and the professor’s function is to
lead the discussion Here the professor has an opportunity to teach meth
ods of research to show the students how to approach a problem, how to

get at facts and how to interpret them

The rise of modem science called for new forms of academic instruc
tion unknown to the medieval university laboratory courses and dim
cal instruction at the bedside of patients These new methods of teaching
so highly successful in the natural sciences, begin to be applied to t
social sciences Political science cannot be Uught in the classroom alone
It requires field work in parliaments and government offices Economic*
IS a dead subject if the student has no opportunity to watch the process
of production and distribution in mines, factories, farms shops, rai ro^^
offices, and the stock exchange And if sociology is to be more
philosophy of history it requires still more extensive field work The c
curriculum is one m which the vanous forms of instruction, lec

seminary course, and practical work are perfectly balanced , ^
The task of university education is not to transmit an estabUshe

UNIVERSITY EDUCATION

265

of knowledge, because there is no such tiling. Science and the humanities
evolve from day to day. If a student left the university with nothing
more than the knowledge accepted in his year of graduation, he tvould
soon be hopelessly behind. The university must do infinitely more than
teach facts and tiieories. It must help the student to develop his faculties,
must train him to think independently and critically, so that he may
form his own judgments. It must teach him methods of study so as to
enable him to keep pace ivith developments. It must open up horizons
for him. lead him in attaining a correct sense of values, in developing
his attitude toward life, in one word, his philosophy. The actual work
must be done by the student himself. Nobody can do it for him. But the
university helps him by giving him the privilege to live and work for a
number of years in close touch with a group of men who have devoted
their lives to the advancement of knowledge.

If academic instruction is to be fruitful it must be based upon research.
Only men who have been actually engaged in research are competent to
present a subject adequately. The student feels instinctively whether a
professor Is merely abstracting a textbook or whether he speaks with
authority. ^Vc all have to teacli subjects that we have not explored our*
selves, but if we are researchers we are able to evaluate other people's
results critically. I am well aware that it is often extremely difficult for
a professor to continue his researches. Many are unduly burdened with
teaching. The rapid development of our universities has created so many
administrative tasks that time and energy of many departmental heads
are entirely absorbed by them. And since tlie professors are experts they
are called upon for advice by the state and other agencies. It is impossible
to evade these tasks. Academic teachers should not live cloistered in their
studies but keep in close touch with life, feeling the pulse of a society
for which they are preparing young people. Departments must be ad*
ministered. They are serving not only present needs but are building up
collections and storing experience for the future. It is increasingly difficult
to be professor and researcher at the same time, and a situation has arisen
that may wreck the university if a solution is not found.

In spite of all difficulties the academic teacher must remain a re-
searcher. It means incessant hard work, and many amenities of life must
be sacrificed. But the compensations are endless.

There is another point to which I would like to draw your attention.
The medieval university was the universitas litterarum. It emphasized
the universality and unity of learning. It is true that it also trained young

266

ON THE HISTORY OF MEDICINE

people to be physicians and lawyers, but medicine and the law were
part of the general philosophy of the time and therefore close to theology
And the students of medicine and law were first trained for many years in
the faculty of arts The goal of university education was to produce an
all round scholar, an ideal that was carefully preserved for centunes The
word doctor means scholar, a point tliat we sometimes forget Conditions
changed in the nineteenth century when the development of science led
to increasing specialization A deep split occurred between the humani
ties and the new science Many universities today are merely conglomera
tions of professional schools with hardly any bond between them

Specialization occurred by necessity No man can possibly embrace the
entire realm of knowledge If science, medicine, and technology have
progressed so tremendously, it was largely due to the specialization in
research We need highly trained specialists But we need more than
specialists If there is so much trouble in the world today, and if it is so
extremely difficult to make necessary adjustments, it is to a certain extent
due to the fact that many men in leading positions are nothing but nar
row specialists whose general and political education has been utterly
neglected

We who have the privilege of living m a democracy have not only
professional duties but also duties as citizens We have responsibihuc*
not only toward our families and the institutions in which we work but
also toward the community and society at large How can we expect a
democratic state to function efficiently if those men who had the maxi
mum of education, who were trained in universities, are mere specialists
unprepared for their civic duties, unwilling to assume responsibility ^nd
leaving the welfare of society m the care of politicians whose only qualifi
cation very often is that they like the game and find it profitable?

It seems to me that here the university has an extremely important
function to fulfill The point is not to set the clock back and to return to
the Middle Ages We shall continue to develop highly trained specialists
but we must give them a broader equipment In South Africa, as in Eng
land, students enter professional colleges immediately after leaving sec
ondary school, which greatly reduces the opportunities for general higher
education In the United States, the requirements for admission to a
professional school include either a completed or at least a few years
course in a college of arts and sciences This is better but still not enough
General education must continue in the professional schools and must be
correlated to the subject of the course Whatever a man's specialty «

UNIVERSITY EDUCATION

267

going to be, he should be familiar with iK history, its sociology, its phi-
losophy. This will by necessity broaden his outlook and increase his use-
fulness.

We must try to overbridge the gap between the old humanities and the
new science, between the social and the natural sciences. If the old hu-
manities include studies in ancient science, they will not die but remain
eternally young, a source of inspiration and happiness for generatiotis to
come. If history includes the history of science, it will become a still more
powerful iveapon in the shaping of the future. If economics and sociology
get closer to the natural sciences and adopt more of their methods, they
will greatly benefit by it. And, if we succeed in bringing the humanities
and the social sciences into the natural sciences, we shall be able to
develop a scientist who will be more than a narrow specialist, who will
be asvare of the place of science in the world and of its function in society.
Nothing could be more encouraging than to see that already there are
great scientists, great specialists in their respective fields, men like J. B. S.
Haldane, J. Needham, H. Levy in England, J. Langesdn in France who,
without neglecting their laboratories, are fully conscious of the burning
problems of our time and are taking an active part in their solution.

My own work as an academic teacher is devoted to the task of prepar-
ing physicians who will be aware of the historical moment in svhich they
live, atvare of their great social responsibiliti^ and of the economic neces-
sities of medicine, so that they will be equipped to take an active and
intelligent part in the life of society and in the developing of a system
of medical services that will reach everybody, whether rich or poor,
whether white or black.

Ladies and gentlemen: Once more I wish to express my profound grati-
tude for the great honor bestoivcd upon me by this university. I appre-
ciate it more than I can tell, not only because it shows me that you did
not regret having invited me to South Africa as a visiting lecturer, but
because it connects me permanently with a university for xvhich I have a
great admiration and to tvhich I have become deeply attached.

It was my privilege to meet many members of your faculty and many
of your students, and I was greatly impressed by their progressive attitude
and liberal outlook. I have no doubt that the young men and women

2GS ON THE HISTORY OF MEDICINE

tramed m ihis uni\ ersiiy v ill exert a marked influence upon llie dwnnio
of the countr}

I sliall be proud to near >ourcolo« m America and I ^\•ant)ou toco''
sidcr me an American outpost of the university vvho vvill ahvays behrppT
to serve you

And so let me end by saying Long live, grovs*, and flourish our tm
V ersiiy -the University of the Wittvaicrsrand

LIVING

UNDER THE SHADOW

rHVSICIANS, a. a rule, are P-

therefore never fully accept the gu objectively; they are

do. They are unable to ,hem toUjust to a disease

perhaps more acutely now than eve the last war, I gradually

It was a new experience to „Hh it when organizing

had to take illness into account and h ^ enioyed the best of health

my daily life and planning for the tutu . responsive

for the greater part of my life and , been seriously

to the many demands of an ac i bich developed into an

ill. when I was stricken with pneumonm

empyema. nerformed, an operation that tvas

I was operated on; a Lxating the pus accurately is no

well known to the Hippocratic oc exploratory puncture, but

problem to us with P<=«“““’'''.,^^ftbe aid of our diagnostic method

the Greeks also found the pus r« break through and that the bo y
They knew the pus would faulty matter. But they

would thus discharge the malen p - time-so long that the

also knew that this process ”'8'’' ' Yatly weakened. Hence it was
patient might succumb or at any mte be grea y

270

ON THE HISTORY OF MEDICINE

advisable to aid nature by draining the pus through an artificial opemni
Where should the physician open the cliest? The Hippocratic doctor ra
soned that empyema was an inflammatory disease in the coutse of whidi
heat was developed The pus must be found at the point of maximum
heat, and how could this be ascertained? In a very simple way a mixturt
of fine clay and water was applied very rapidly to the back Where it dmd
rs , t ere was the maximum heat and there the incision ivas perfoniied
.n , ° pneumonia— It was an ordinary pneumococcus infection-

s ea o eve oping into empyema and keeping me in the hospital for
many weeks, would be cured in a tew days, and this reminds us of the hfl
tnat the historical moment at which our individual life unfolds ha! a
ong oaring on our health and illnesses How many of our contempo-
les wit la etes, pernicious anemia, and a variety of other dueass
teen lost inexorably only yesterday
haw people today are dying young on battlefields who miglit

around the middle of the

ha 7 arH ^ ® Undertaking to try to decide whether it k

tn ns hf atever we may call it that determines what happens

the chromosomes and behavior To Paracelsus

Isfrfl ^VJT I. o” and he spoke of e«

thp nntrn- ^ 'vhich disease befalls man The fact remains that

space at which we live is extremely impor

hndv ? ^ illness Like every

th /t f” occasional cold or upset stomach, and I am ashamed to say
, cf enjoyed these minor ailments It is a sad comment on our

y o 1 e t at we must have a sore throat, a bronchitis, laryngitis or
pstroenteritis, in order to have a few days of real rest An interesimS
ssay cou e written on the hygienic significance of minor ailments By
orcing us to rest they may prevent more serious illness Of coiine ■<
nT n '“"8 by taking a trip to die West

Indies But how could we get away in the midst of the academic year, and
what professor has the money for such a tr.p anyrvay?

Bronchitis or some such disease is the cheapest way of having a vaca
non and spending a week or even a tew days m bed is the best rest ue
can have The discomfon is nothing to speak of. we catch tip with sleep
and accumulate a reserve tor the weeks to come we eat little and tale
oil a tew pounds, and we have the time to read all the books that have
accumulated on our desk However, m order to enjoy the privileged

LIVING UNDER THE SHADOW

271

position granted the sick man we must be feverish. As soon as our tem-
perature is higher than normal we are excused from all the many duties
and obligations imposed upon us by society. Tortured by gastric ulcers, a
man is still expected to attend to his regular work and is often considered
a nuisance because he requires a special diet, while the slightest fever
makes us an object of attention and loving care. A fever makes it appari*
ent to all that tve are sick; ulcers do not.

The years have gone by, and now at the age of sixty I find myseit witn
three incurable diseases. One is a rare but not significant disease, a
parapsoriasis en plaques. A textbook describes it very correctly as being
characterized by "widely dispersed, well-demarcated, superficiah non-
infiltrated, pink to tan patches covered with a fine adherent scale.” They
do not itch or present any other subjective symptom, do not attack the
face or hands, are not contagious; they come and go, disappear at times
entirely, particularly during the summer months, come back and are
more strongly marked in winter. ^ t • t *

Nothing is known about the disease, and there is no cure or it. t is
possible to get rid of the patches temporarily with chrysaro in or, un er
certain conditions, with large doses of vitamin D, but they
after a short while and the best one can do is to forget about t e isease
and ignore it completely. This is very easy at my age, but, or
people who like to display their anatomy on beaches and *

courtship, such a disease, harmless as it is, could be rnost unp easan , p
ticularly as the prejudice against all skin affections is still ^^^7
also reminds us that in spite of great progress achieved we sti ave
unsolved problems in medicine, and it makes me feel very strong y
unsatisfactory our theory of disease actually is. Is parapsonasts plaques
more than a name? Is it really a clinical entity, a disease in
Or is it merely a symptom in a larger complex, symptom o a as
logical condition such as an allei^? . , vpars

This leads me to the second disease which I have a
now and which has caused me more discomfort than the on j
tioned, a chronic rhinitis. It developed slowly and gra ua y
come from Europe to America. I noticed that very , j

' develop diseases of the upper respiratory tract in -^tnenra, p
' sinus troubles. The violent climate with its sudden chang P

272

ON THE HISTORY OF MEDICINE

ture, the polluted air of many of our cities, the overheated room! m
which we live during the winter, may be partly responsible for thi! Hiv
mg worked in a library for many years, I know what fatal effect the damp
heat of a Baltimore summer followed by the dryness of an oietheiltd
ui ing in the winter has on the leather bindings of books, and I can vdl
imagine that the tender mucous membranes of the nose do not react ini
particularly favorable way to these external factors I was treated inlh
a” when the drug was still in its experimental stages, ivas treated
with radium, was operated on Most treatments gave me temporairb"'
no permanent relief It could never be established with certainty whetbei
e disease ivas due to a chronic virus infection or to an allergy

any rate, have it and will in all probability keep it to the end Itn
nuisance, I cannot deny it. and many times I envied our BaltmoK
noses which seemed to guarantee them perfKt
. ^ egree of comfort or discomfort I experience depend!

weather There is an optimum humidity "hich
dee^r, eT With a higher or loner

Strfrnn^' however, the membranes swell and came nsal oh

readmes. « ,i,''°il nccept the condition and have some drug! m

at niaht I h °P^" 7°“

mom®^ 1 Xh" ^ lecture, at a conference, or at some other cntioj

inr,?4w A ® compared with my tkiri

mcurable disease, which is a senous one, a killer

iinivi^sTt' '7'"''^ j'*” ^ jottied the faculty of an Amencsn

fesm-?rZ' “ “">>>■"' a life insurance policy with the phc

edlv annuity, and the medical examination very unexped

and a few ^ t ^ marked hypertension, with traces of albumin

Perh,™ 1 1 . m => ®'>gt>tly enlarged left ventricle

severTmllf™ h"”' *1“'“ “"expected, because I knew ol

hvoerilr a ” Were suffering fro®

o™?eZ “ cariiovasciilar diseases I

ZrdinfanZ^T' practically no exercue

leading anything but a hygienic life

"«E' I was not accepted by the life msuiance
^ / I”"’'"'’ ®wtss companies do accept h)perten!'«

ind 1 .duals at a slightly higher premium Quite generally I found Hint the
attitude of tlie medical profession toivard hypertension is different m
Switzerland-and in other Fi,r«« r .u,. usually cn

Ssvitzerland— and

- — w. ,.....*v/pciin countries— irom mat »
countered in America Much less fuss is being made Statesmen

other European countries— from that -

7 1... r . . _ busine*5

LIVING UNDER THE SHADOW

273

men, industrialisu in very responsible positions, are strongly advised to
carry on with their work and not to resign; high officer of the general
staff are kepi in the army. They all have to make certain adjustments, to
be sure, but every effort is made to impress upon them that they are not
cripples, that they remain useful members of society, that hypertension
is not a disease but a condition, an adaptation of the organism to certain
pathological changes. As a very distinguished Swiss clinician said to me,
it took a long time to penuade the general practitioner that he should
measure the blood pressure as a matter of routine, but now he must be
urged not to overrate his findings. Of course, in Europe as everysvherc
else, physicians and patients are well aware that the condition is serious,
but there is no reason to become neurotic about it.

In my own case it is difficult to tell whether the condition began as an
essential hypertension svliich gradually caused cardiovascular lesions or
whether it was the result of slowly des'cloping arteriosclerosis. I noticed
that most American colleagues I consulted were extremely secretive.

they took the pressure and you asked them what they had read,
they gave you a \*ag\ie cs'asive answer which sounded cither like a dark
threat or like a light joke. I once spent two weeks for a general checkup
at a famous hospital, had an endless number of tests made on me, and
not only svas I never allowed to sec my case history but I also tvas never
told what my blood pressure was, what the ophthalmological findings and
the results of the various tests had been.

Of coune I found wa)'s and means of getting hold of the case history
surreptitiously, and I suppose most physician-patients in such cases do,
but I strongly resented the secrecy of my colleagiies, which implied either
that 1 bad never heard of the fact that man is mortal, or that they con-
sidered me a highly neurotic individual who could not be told the truth,
and this I am decidedly not. The result of this secrecy was that for a
number of years I didn’t consult a doctor until I found a very able young
Viennese refugee physician who svas absolutely frank and together with
whom I made the necessary tests in his small laboratory.

AH this raises the very important question whether patients should be
told the truth about their condition or not. a question which, I am sure,
cannot simply be answered with ''yes" or "no." Medieval ethics had no
hesitation on the subject. The purpose of man’s life was salvation, and

274

ON THE HISTORY OF MEDICINE

everything had to be done to prevent a man from dying unprepared,
■without having confessed and received the holy sacrament of extreme
unction Today the commonly accepted view is that the physician should
not do anything which might harm his patient, shorten his life, or even
worry him unnecessarily If a true statement about his actual condition or
a prognosis might in any way be harmful, it should be withheld par
ticularly as the physician s words may easily be misinterpreted at a time
when radio, newspapers, popular magazines, and advertisements are
pouring out half baked information on medical subjects This sounds
very simple but is not, and here as everywhere else the doctor must know
his patient

No two individuals are the same physically or mentally, and svhile
some demand full honest information about their conditions others are
—unconsciously— grateful for being kept in the dark I know members of
my own family whom I as a physician rvould deceive to the very end
because they could not take the truth, while I know others svho would
be deeply grateful if I should tell them the whole truth, because it would
make it possible for them to organize their life, whatever is left of u, in
the best possible way

Of course, we must always keep in mind that m medicine there is no
truth with a capital T, that medicine is what Celsus very aptly called it
an ars conxecturalts, an art in which you have to make guesses There »
more certainty today in our knowledge of diseases, in our diagnostics and
even in therapy than in the past, but the area of uncertainty is still very
large There is a school of physicians that strongly believes that hyperten
sive patients should use a saltless diet, while other schools think that salt
does not affect the blood pressure in any way And the advocates of a salt
less diet are divided into two camps, those who consider the chlorine
harmful and those who accuse the sodium of evil effects Pharmaceutical
firms have prepared condiments to take the place of salt, some of which
contain sodium but no chlorine, while others avoid sodium but have
chlorine There are plenty of experiments and statistics available m sup-
port of all of these views Which is correct and which ivrong? We do not
know The explanation may well be that patients react differently

When we have decided to enlighten a patient about his condition '
must never forget to tell him that there is always hope Miracles do ap
pen m medicine My mother had a maid who had served her for
thirty years when in her late forties she rapidly lost wei^t One o
best gynecologists m town diagnosed a cancer of the uterus and dec

UVING UNDER THE SHADOW

275

to make a total extirpation ot the rvorab, but when he opened the abdo-
men he found a very advanced tumor and metastases, so that nothing
could be done. Biopsy confirmed the diagnosis. The rvoinan was pen-
sioned, went back home to her village, and ut aliqmi fiat !.hs went once
a week to the nearby city to liave treatment with X-rays. Soon thereafter
h beg^^ to gain JeigJt and recovered so completely that lived for
alLst^wentyTive years, dying at a ripe old age,

World War II while I was in America and long after her gyn ^
passed away, so that nobody thought of having an

My own condition remained quite *?HoXs Im

ing tie war. Those were busy years,
stitute of the History of Medicine rvas d^oped the
ton of Medicine and several series of mono^ap activities

American Association of the History of Medicine “'“fd mjt.v
-years of research, of teaching, of =dn.m.strative woA K„owi^^^
war was bound to come, I took advanuge o ivorking

peace and went abroad every summer for “ ^ ' medicine. And at
in libraries and archives, or doing field work to see

the end of every summer, before s^dalt t’o ta" a chat

an old friend in Zurich, a d“tm^is msssure rvas invariably the same,
and to have a few tests made. The bio p . urinalysis were

about 160/110, and after X-ray, ^"fmS ned to carry

found to be unchanged also I sailed back to Am ri a determm

on as in the past. I never felt “^ "^"".jVhen America became Involved
Matters changed as a result ot th armed forces and we,

in the conflict, our younger o£ years I had three full-

the old generation, did their strenuous. It meant

time and a half a dozen part-time ) • sleeping tune

having a seven day working dlcldedly not the way of life

reduced to a maximum of five no • , But then others were

usually recommended to hypertensive i share on the home

dyingln the battlefields; why should we not do our
front ivith all the risks involved? because every summer

I rvas able to carry on during ‘h^^ljl'^meuse benefit. I know
I spent a few weeks at Saratoga p o highly of spa

that the average American doctor psychotherapy if not

treatments and considers them ra ^ springs have been used with
outright quackery, tvhile in Europ treatment of chronic diseases,

good results for the last 2000 years m the treatment

276

ON THE HISTORY OF MEDICINE

I am not competent to decide what biochemical processes take place in
the human body during such a treatment Scientific balneology is still m
Its infancy, but research is being pushed vigorously in a number of Euro-
pean countries, particularly in the Soviet Union

What I do know is that a few weeks of complete rest and relaxation,
away from everything and everybody, with light exercise, walks in the
enchanting landscape of northern New York State, combined with a strict
reducing diet, mineral baths, massage, nasal inhalations, did wonders for
me Each time I reduced my weight by ten pounds, my blood pressure
went down by twenty to twenty five points and stayed down for some
time I went back to work feeling light and rejuvenated

One point I should like to mention and stress in this connection
namely, the importance of solitude and meditation We are social beings
whose life unfolds m a closely knit society The city dweller, men in
public life, academic teachers, physicians, business people, are practically
never alone From the moment they rise in a hurry m the morning to the
moment they retire at night, tired and weary, they live in constant inter
course with other people They never have any time to reflect about life
about the world, about their own doings I think everybody should make
an attempt to spend some time alone every year— if not a few weeks, then
at least a few days— reassessing his life, trying to find out what was right
and what wong, making plans for the future, reviewing his scale of val
ues It need not be in a health resort, not even m the country Many times
have I been on a lone island, cut off from the world in the midst of Parj*
London, or New York, and have experienced moments of profound so i
tude and great inspiration within the bare avails of a small hotel room

In 1945 when the war came to an end I woke up to the realization of t e
fact that from now on 1 would be handicapped physically h i* quue
shock, at first, when you find out that the body no longer is the wi mg
tool of the mind, when you discover that you cannot jump up the stairs
any longer as you used to do but must ivalk up sedately like other peop ^
At the moment I live surrounded by hills and mountains that I I'OU ^
to climb, but I know that I shall never be able to do it But then you '
soon realize that these arc very minor considerations Once past *
of fifty, almost everyone has some kind of handicap One is hard o c
ing, another has trouble with his eyes, still another suffers from ar n

LIVING UNDER THE SHADOW

277

but as long as the mind is alert and functions normally there is no reason
why we should not accept our lot joyfully.

Every chronic illness presents special problems. With a cardiovasc
disease you know that you will not live to a very o d age
know that the end may come suddenly. How many o
ouaintances have been stricken all of a sudden, out of a blue sky as
Lmed, in the street, at their desk, in the teture hall or
in their sleep. Since the time left is limited, we must plan carefully so ^
m “ tL utmost. We must decide which part
sider the most important, and this we must try to carry out no matter

what sacrifices it may require. ir,vp<1 and set up

In my own case 1 gave up an ^iuertad ^ to

my workshop in the ““"‘^XThld been preparing for many years
wite an eight volume book that I sooner. I felt that

and that war work had prevented me om ^ fragmentary, and

without this hook "V ;“cSor r

arto"d;^Xtt:rA^n u«
port me and my work for a ^ university, and whatever

an unusually liberal and generous ® „seiftsh support. Most

I may achieve will to a large extent be f X'n their position

professors with ray illness would have a routine without being

and wear themselves out with teaching and endless
able to complete their essential srark.

I think this feeling of not having comp , . gre yean of research
a message to deliver, of wishing “P incentive but at the same

and manifold experience, is not only S oreanize your entire life

time an important therapeutic f,,nhe^t, and^void what may

around the project, do anything t at wi it very easy to give

be detrimental to it. An inveterate smo ' book. ^Ve know of many
up smoking when I began finished their task and then col-

people who kept alive until they a ^ Recherche du Temps

lapsed. Marcel Proust mote feverishly, in bed most of

Perdu under tremendous handicajM, I'O ..r ^d the society in which
the time, and when he had recreated his past life

he had lived he died. before they had com-

Of course, we know of other ^jdjt of it. Yet we ob-

pleted their work, who were tom a J certain date keeps patients
serve quite often that the desire to Use to

278

ON THE HISTORY OF MEDICINE

alive Dr Welch, after many months of illness spent m the hospital, saw
the end approaching, but also the fiftieth anniversary of the day when he
had joined the faculty of the Johns Hopkins University And he wanted
to live long enough to see that day. He spoke about it often, and indeed
It was a memorable date— half a century in a university which during that
period had become one of the great cultural centers of the nation and to
the greatness of which he had contributed more than anyone else To
him It was symbolic of the fact that he had completed his mission on
earth The day came, and he thoroughly enjoyed the flowers and tele
grams he received Then his illness took a quick turn for the worse, and
he died a few weeks later.

And now I have been living in the country, working on my book for over
three years I do not feel sick m any way because I am in an environment
m which a man with my illness can lead a normal and full life and be as
productive as before I lead a very quiet life, move around very little
physically, but feel that mentally I am embracing the globe because my
book, a history of medicine from early beginnings to the present, taVes
me all over the world and through five thousand years of human civilua
tion I live surrounded by books m many languages from many lands
and each one opens up a world At nine o’clock sharp I am at my desk an
spend the whole morning writing During the afternoon I attend to a
very extensive correspondence which keeps me m touch with all comers
of the world, iVTite an occasional book review, and take care of the m
finity of odds and ends connected with literary work, preparing bibliog
raphies, collecting illustrations, reading proofs, and similar matters After
dinner until midnight sharp I read texts and make notes and in genera
prepare the following morning’s ivritmg This schedule is by no mea^
rigid. It may have to be modified according to the urgency of some wor
I also greatly enjoy the visits of former students, of colleagues and fnen
who are good enough to look me up in my retreat

Thus I feel that I am still a useful member of society, not a
and that 1 am contributing roy share to the advancement of know e g
My adjustment was relatively easy because so far I have not had to 'vo
about my family’s livelihood or mine, and also because I am engage
the kind of work that thrives best in the wilderness, provided
a good library of your own and university libraries send you books

LIVING UNDER THE SHADOW

279

biochemist, who requires laboratories for his work, or an engineer, it is
mom difficult to change his mode of living. But I th'f f « 3,
with hypertension can adjust in some way or other. If ™

doivn in his accustomed occupation, there is hound to be — thm he
may take up. It is important for us to reaiite that we «n
tory life on a much smaller income than we used to have. With a sha^
en?d mum of Wlues we soon find out that much that we thought we h d
to buy was quite unnecessary. The more ^

look and attitude toward life has been, the easier our
" are getting on in age. we draw from the
capital that we have built up during a lifetime and we reap

’'"of ioTrie it would be absurd to think that a ^rdiovascular condirion
0 f?in 7 years- duration does not present any feeUng

cannot rVn or carry weights without getung out «£ iflfh^e to cati
some oppression in the chest. But 7?“^ J t ^ porter to

So far I have not noticed any signs of
and I think we can do something to ° ^ verses every day

for example, learning difficult poems y languages. For the last

while shaving-or engaging in ‘ "‘"'’j language studies every mom-
fifty years I have devoted [“Sbfe. Rnssian-whichever

ing, learning and practicing Gr , „oeded most for my

I happened to be interested in use— every day, you not

work. If you learn three a stable vocabulary in many

only train your memory but a q Utenttures as

tongues in the course of time, and you w l enj y

you never would ‘'7°".*''“* “.’T U" ‘^s to certain personality chanp.

Prolonged hypertension f f * have become very sensitive

I used to he rather thick-skinnrf j should

irritable, impatient, getting counteracted to some ex-

not have even noticed in the pas ^ exercises, and on some occa-

tent through will power or certain _ This increased sensitive*

sions one may have to take recouw to s more but have much

ness has its great compensations, much more

f3;Sne?er\l7;^l«7-2;price.essprivi,egeofl^^^^^

280

ON THE HISTORY OF MEDICINE

in the country, you ivtil find the unfolding of the seasons in their eternal
rhythm, the miracle of spring, the exuberance of summer, the soft mclan
choly of fall and the creative pause of winter, a constant source of ela
tion and inspiration You soon recognize that the blossoming of a rose is
a much greater miracle than atomic energy, and certainly a greater source
of happiness I find that every handteap has its compensations I sleep
badly, but this has the advantage that I sec the sun rise, which I never
did m the aty

Therapeutically there is very little you can do in a case of hyperten
Sion There are drugs that reduce the blood pressure drastically, but they
do not cure the underlying disease and simply destroy the compensatmg
mechanism The best we can do is accept the disease as a permanent tac
tor in our life, adjust our mode of living to it, keep our sveight down, eat
and drink moderately, and rest from time to time

Rest, complete relaxation, is a very important healing factor Former y
I spent every Sunday working because during the eight months o t e
academic year Sundays are the only days that you can devote entirely o
research and svritmg Now I rest on Sundays attend to my
about once a month I spend a Sunday m bed resting and fasting c*
are red letter days for which I always save up a book that 1 am particu
Urly anxious to read I think the importance of fasting has not w”
sufficiently recognized A forty hour fast during which
nothing but fruit juices decongests the organism and has a very
effect I also do all ray ivriting in the morning on an empty stomac
I found long ago that I work mucli better before than after meals ^
And so with three incurable diseases 1 have been very fortunate, an^
I only wish that things may continue as they are for a few more yean
that I may complete my work And I also wish that I may be
end my life at home and not m the hospital I have a horror o t e
pital, tliat blend of penitentiary and third class hotel Of course
hospitals and we must be grateful that there are so many excel ent
Many examinations and treatments are impossible or at least
cult outside of a hospital But it is a dreary place, nevertheless wi
sterile looking rooms bare svalls high beds, and the necessary
routine that makes it so difficult to rest The rooms are obvious y
made to live m but to be treated in, and even the flowers that
so kindly send us rarely succeed m brightening the room
are no organic part of it and rather give it the appearance o a
parlor. How much nicer it is to be sick at home where w c hav e our

LIVING UNDER THE SHADOW

281

where the cat takes the place of a hoMvater bottle, and where we may
count on a decent cup of tea.

We all knorv' rvhat the final stages of such a cardiovascular disease are.
There are various possibilities, some of which are less desirable than
others. We also knotv that death may come unexpectedly from an unre-
lated accident or some intercurrent disease that a weakened heart is un-
able to overcome. But tvhatever fate may have in store for us, we must
be prepared to accept it and to die as ive have lived, rejoicing at the
thought that it tvas given to us to live through a fascinating period of
history and to take an active and creative part in it on the progressive
side to ^vhich the future belongs, rejoicing also in the knowledge that -we
are leaving children and former students behind who will carry on from
where rve stop.

AMERICAN TRUFFLES:

A THANKSGIVING FANTASIA

ROAST turkey prepared in the good old American
New England stuffing and served with cranberry sauce is a great (hs . ^
I prefer my turkey truffled and served \viih a sauce P^ngueux w
quires some preparation but is not too difficult to make once you a
mastered the elements of the art of cookery You must buy your
in time Then, two days before the event, you slice some of
and insert the slices delicately with your fingers between the s m
the meat of the bird without destroying the subcutaneous connective

sue altogether H ce it

Then make the stuffing Take some fatly tissue of the turkey, i
and cook it with butter, chopped bacon, chopped truffles, a sma c

onion, the whole well seasoned After it has cooked for a ivhile, eti

add plenty of fate gras, the liver of the turkey, more chopped tru ^ .

fill the abdominal cavity of the bird with this mixture And t ^
about It for two days During that period the meat, expose
sides to a barrage of truffles, will become impregnated with t eir
flavor .

When the day finally comes, roast the turkey in the classica w y
ering it in the beginning with paper that has been soaked in me e
ter or olive oil And, while the bird is in the oven, make your sau
gueux m the following way Cook in butter minced marinate
and ham, add flour, brown, add slowly rich chicken stock an a g
good old Madeira, cook in double boiler, add minced mus ro

AMERICAN TRUFFLES

283

truffles and at the end some of the fat from the turkey. Do not forget
salt and pepper. If you happen to have a maid, tell her to come after the
dinner to Tash the dishes*^ and serve the turkey yourself bemuse m
and sauce must be served together steaming hot-ivhich a maid neier

This truly is a delicious dish, and I shall be glad to give a niore de
tailed recTpe to any member in good standing of American «
tion of the History of Medicine i.ho is a qualified

to prepare such a turkey for the benefit of the ^mily and o a Jew hien^^
But now the trouble is that there are no truffles. ®ea ®

from France. And bemuse we have not yet reconquered
province where they are cultivated. And because if
it the Nazi General Staff would have eaten ”P J, that
Truffles grow also in England but these truffles betong to a ^p^c
is much interior to Tuber melanosporum, the best truffle

The Army Medical Library, which ^ “ ,^h°ch Uomd Tn

medicine, possesses some literature on tru ' Pennier de Long-

interesting pamphlet ivritten by * physicomidi-

champ ^ if, and published in Avigno ,

cale sur les Truffes et sur Us Champignons.

The author tells us how he came to write this treatise.

Discoveries are often wade by accidenl and Uh owes its origin to

investigations. The dissertation that I aw pres g ^ ,

a joVe that was made during a “^1 know the virtues of all the plants,

many truffles. Since my profession ob '8” j j answered that the generd

I was addressed and ashed what effects finding himself m

opinion was that they were invigorating an should eat many truffles m

a weakened condition undoubtedly oug when I tnaiie

order to restore his powers. The me was

business to analyze them. ^ ^ ^ time was

We can well Imagine what the with old houses

the same provincial and gossipy ^ humor and like

and narrow streets, with people who have I„ ,he shadow

good spicy food and the tvine that , come together for dinner,

of the Mace of the Popes a gmup °t th™ J b„„dy,

A dish was served, hot truffles that had been sprt

284 ON THE HISTORY OF MEDICINE

wrapped in bacon and in two layers of paper, the first soaked in oil, the
second in water, and then roasted in hot ashes A young man fell to and
devoured them gluttonously, whereupon the whole “

kid him, wondering how he had spent the last night The doctor should
know, and they all looked at him Dressed in black as became a man o
his profession with a jabot of lace and a wig he tried to look 5=™“
confirmed the general suspicion And then it suddenly oc™™ “
that, while he liked truffles like everybody else, he knew very little about
them, and he decided to find out more ,

Actually he did very little himself He tells us quite candidly that
analysis was made by a friend H.s oivn major effort was to “P ‘

literature If anybody should have information about truffles it ce J

would be a member of the Aeademy of Sciences, and indee
Afemmres de I Acadimw Royalc des Sciences he found a paper,
rations sur la V4g4tation des Trufles " that had been P;«'"'“ ™
ary 25 1711, by Monsieur Geollroy le Jeune Claude Joseph
(1685 1752) a pharmacist by profession, was remembered as having
an excellent chemist and botanist, and the author felt that t e
could do was to paraphrase his paper, adding a remark here an
which he actually did m

Since the truffle is a subterraneous fungus, it therefore was 7 ^

aling to eighteenth century naturalists They agreed that it mu
plant, not an excrement of the earth as some ancients h^ t 0 g
plant that had neither roots, stem, leaves, or flower Tru es
peared on French menus since the end of the fifteenth century, a
Geoffroy le Jeune and Pennier de Longchamp were familiar wi
growth, cultivation, and gathering The conditions they picture
much the same as still exist today They tell us that truffles
tivated reddish soil at the foot and in the shadow of ^ cal
oaks And indeed we know that they grow best in light an
careous clay soil, in association with oaks, particularly t e s
green oaks of southern France 1 ed by our

Truffles ha\e to be hunted,” and the three methods descri 7
authors are still m use today. The first, and still the thu

France, is to hunt truffles with a pig or, better, with a sow,
is an animal that loves truffles and has a very fine nose scsso'^

pig may find over twenty pounds of truffles in one day during
But ivhenever it finds a truffle, svhich 1 $ then taken away, you
pensate the pig wiUi a few acorns ‘ because otherwise,” Pennier

AMERICAN TRUFFLES

285

champ adds, “it would not persevere in a labor that is m no way proBt-
“"The trouble with pigs is that they are sviUul animals ™omover

iiissss=

x-rs „ . «.« til

neither pig nor dog. In such a case 1““ landscape that sur-

tniffles. You lie flat on your spot you may

rounds you. If you see a swam o trufflf flies that have the

hope to And a tniflle there, because these arc trume

vicious habit of laying their eggs in pspally served as en-

“Truffles,” Pennier de Longchamp tells us are usu l y

Iremels and our gluttons or j eaten and thus de-

assume that they precipitate what has “ ' , „ admit that

velop new appetite." Medically tn-mes are hot and m ^

this is not one of the best kinds f”® individuals of sanguine and raw
ties nor of its modes of P^^P“”''°"’^“ „ho by vocation are obliged
temperament should not eat them, nor those wno oy

to lead a life of chastity.” . .^-nv v»*ars’ experience, we

As modern physicians and on the p^rigueux does not in-

can safely state that a truffled turkey , is hardly more than a

volve ani; health hamrds^ The heat u p^^um is

pleasant feeling of warmth— and i

m Trance -we obviously look to

Since we cannot obtain ^ ’ t country that produces

America as a source of supply* American truffles?

almost everything. ^Vhy should ^ reasons for supposing

And indeed there was a time ^ jn ]812 a famous Amer-

that the truffle was a native nf the United Columbia Univer-

ican doctor and chemist svho was wn following let-

shy, Samuel Latham M’"*"*' ^ comprehending ortgmal

ter in his own journal. The Meircol Repor^ rtemWo., ualuwi h.ilory,
esmys end intelligence more 'erf emfly “

agriculture, geography, ana tne >

288 ON THE HISTORY OF MEDICINE

never heard o£ m bemg ured far any dung »cep. .o nrate starch (?) He ha, never

been able fa get any ammal lo»I n root was over seteit

The specimen resembling in external appearance p respectively three

inches long and showed ™ transverml about one

and 6ve inches diameter The cortical part is of a bro™nn ^y
sixteenth of an inch in thickness yay rough with „ed by deep

centric elevated rings in several places i, was “7” „t widi a

depression, The interior part of the fresh fungvu u easdy to b
knife homogeneous without any smiaure a „„ direction and

to the air it soon begins to harden hariened state it u

ultimately the substance becomes very hard and toug „ to lay it m

almost impossible to powder it The best way to ° a pestle

warm water wherein it swells and faen fa break a fa ot appaJend,

The fungus under my observation has a nucleus in
of a conifefau, tree This root gt-tront. cortical

a diameter of about three fourths of an in* Th

part hut the white substance of the fun^ hn ^ „ appearance

I different appearance it has more of ^

while the mam portion of the fungus has become quit g,,

the cortical part of this root gave m a certain sute of decay the nn
formation of the fungus

The author then gives a detailed Y ''‘^/of^hich is

the fungus contains pectose, a little sugar and two
oxalic acid but no starch and no gum This made it

of cookery had nothing to expect from that fungus ,ua,„catpro-

My last hope was the U S Department of AgH“»“^ J„ut
gressive scientific institution of our government If J ^^^ed a

American truffles they would know I wrote and imme y ^
very courteous answer, for which I am much indebte
Hardmg Mr J A Stevenson, and Dr E B had

sad 1 learned that none of the truffle species of g.d oc

been found in the United Sutes although several P ,,,e (set

cur in California Minnesota and New York Quite apa
that American truffles should by definition be bigger an
European ones it was all too obvious jhat those small sp
the Tight kind

If there are no American truffles of the best species, "[''I' ”',g ,„^rt

them? We have the soil that is needed We have oaks or

AMERICAN TRUFFLES

289

them. We have intelligent pigs and very clever dogs so that there is no
reason why we should not develop a P^igord in America.

Yes, but there is a snag, namely, that it takes many years to develop a
truffle industry so that it will be profitable. Once the soil has been pre-
pared and acorns or seedlings of the right kind of oaks have been planted,
truffles may appear after about five years, but it will be five to ten more
years before the yield may become profitable and perhaps twenty-five
years before it reaches its maximum. Hence the prospect of a truffle in-
dustry cannot be very attractive to our individualistic system of free
enterprise. "We have not such strong dynastic feelings that sve svould sow
for the next generation to reap. Oh, we like to call ourselves John Doe,
II, III, IV, V, . . . IVe also have a very soft spot for kings— as long as they
are in Europe- As a matter of fact, there are several kings today whose
cro^vns are tottering and who look to us as to their only support. But
when it comes to investments sve like quick returns.

The production of American truffles, therefore, tvould have to be dc'
veloped as a government project, by Washington "bureaucrats,” under
the auspices of the Department of Agriculture. But then— good God—
the truffles thus produced would be socialized truffles. One might even
call them "sovietized truffles,” and it is obvious that no self-respecting
Republican could eat them.

I can well imagine what the reaction to such government truffles grotvn
at the expense of the taxpayer would be. The National Manufacturers
Association and the Chamber of Commerce would issue a violent protest
against such unheard-of government interference that was undermining
the American svay of life. The Council on Foods and Nutrition of the
American Medical Association would investigate the matter and would
publish a memorandum pointing out that truffles are un-American, a
European racket for which there was no need in this country. They
%tfould draw attention to the fact that under our American system we had
succeeded in raising the biggest and best turkeys in the svorld, that there
^vas a turkey for everyone svho knew how to ask for it, that bread stuffing
iras much preferable not only because its nutritional value was much
greater than that of truffles but because it conformed to American life.
Whereupon the House of Delegates rvould pass a resolution with all votes
against those of California— where good food has always been appreciated
—condemning the use of truffles. The docton of Indiana svould even go
one step further and tvould organize an association of American phj’si-

290

ON THE HISTORY OF MEDICINE

cians and surgeons, the members of which would pledge themselves never
to eat any truffles in whatever form they might be served
And so I am afraid that we collectivists who simply adore regimenia
tion and therefore like to eat our turkey truffled with sauce P^ngueux
will have to wait until the war is over and we again can get truffles from
France And this year we shall for once be individualists and shall pre-
pare our Thanksgiving turkey like everybody else, m the good old Amen
can way See Fannie Merritt Fanner, The Boston Cooktng School Cook
Book, seventh edition, completely revised by Wilma Lord Perkins, with
new illustrations, Boston, Little, Brown 8: Co, 1942 p 393, ‘Roast
turkey , p 211, “New England stuffing 12 slices bread, inch
thick . .

THE SPELLING
OF PROPER NAMES,
OR

THE IMPORTANCE OF
BEING ERNEST

VERY historian and bibliographer knows how difficult it often is to
ascertain a man's correct name. In Europe before the nineteenth century
the spelling of family names w-as not rigidly fixed. They were witten
phonetically, and, since the same sounds could be expressed in different
ways, the spelling often varied a great deal. I once published a letter wit*
ten in 1766 by a Swiss physician whose name occurs as AepU. Aeppli, and
EppU. Since the family still flourishes and today writes its name Aepli,
my doctor is usually found in the literature as Johann Melchior Aepli,
but in the letter I published he spelled his name EppU.

It frequently happened that a man changed his name deliberately.
Napoleon's family name was Buonaparte, and he changed it into Bona-
parte, which sounded less Italian, a spelling that svas generally accepted,
although not immediately. His aristocratic enemies liked to call him
Buonaparte in order to recall his humble origin.

In the case of famous men of the past, a definite spelling has been
established and today nobody would think of spelling Shakespeare in any
but the customary way. But in the case of minor deities it is often very
difficult to decide which spelling should be accepted and confusions are
unavoidable.

In the nineteenth century most European countries required individ-
uals to be registered with the authorities, not only at the moment of
birth and death, but whenever they established a new residence, and
everybody carried a load of official documents identifying himself. Names

292

ON THE HISTORY OF MEDICINE

were frozen and could not be changed without special authorization,
which, unlike m America, was and still is difficult to obtain

This made the task of the historian and bibliographer much easier,
but even today confusions occur very frequently, chiefly as the result of
carelessness It is almost unbelievable how many people are unable to
copy a name correctly, and once a mistake gets into print or into an offi
cial document it is difficult to eradicate

Being interested in the sources of such mistakes, 1 watched the mis
spellings of my own name and the following story, I am sure, could be
duplicated by every one of my colleagues

My family name comes from the Latin sacrtstanus, the sexton in the
church In upper Italian dialects, the ending was dropped and the word
became sacrista It penetrated into the AlJemanic German of Switzerland
and south Germany where it became sigrtst, the word still used to desig
nate the sexton The pronunciation, however, varied The first i was
sometimes long, sometimes short, and ilie word was sometimes pro-
nounced m two, sometimes m three, syllables As a family name it was
therefore spelled Siegrist, Siegenst, Sigrist, or Sigenst Since in Switzer
land most families of this name spell it Siegrist, my name was very f«
quently misspelled in that country More than once I had to have an ofn
cial document rewritten because the clerk was unable to copy the name
correctly, and whenever I published a paper in a Swiss journal I w**
pretty sure that I ivould have to correct the name on the galleys I h^vc
no doubt that Professor Samuel Eliot Morison of Harvard has the same
difficulty in keeping the second r out of his name Outside of Switzerlan ,
where my name is not frequent, there is no reason for its being mu
spelled

My book Einfuhrung in die Medizin was first translated into Sivedis^
When I received copies, I saw that my name appeared on the coser
on the title page as Henry M Sigenst My German publisher proteste
and the Swedish publisher very obligingly had a new title page ^n ^
new cover made, but a good number of copies had already been solo
Swedish librarians iviU have to find out what M stands for
Two years later, in 1953, a Dutch translation of the same
published in Holland It was prepared by my colleague and fnen J
de Lint On the title page my name was H E Sigenst, but in the m
of the book I was listed as Sigenst, Henry Eduard
Again a feiv years later, in 1936, the same book was translate
Chinese There my name appeared m beautiful Chinese characters

THE SPELLING OF PROPER NAMES 293

since it is almost impossible to identify a European name from Chinese
characters the publisiier had added my name in Latin type, and there
I became Henry S. Sigerisi.

My middle name is Ernest. 1 bom and brought up in France, and
on my birth certificate my middle name was spelled in the French way,
Ernest. Thus it remained ever since, for over half a century. Whether
1 lived in France, Switrerland, Gcnnany, England, or America my mid-
dle name still was Ernest. I ts’as therefore very putzled when I noticed
that in America I was frequently and sometimes in very formal docu-
ments addressed as Henry Ernst Sigerist, with my middle name spelled
in the German way, and I often wondered the source of this mis-
spelling was. Who's Who and other biographical dictionaries list my
name correctly. Their entries are based on questionnaires, and galley
proofs are usually submitted to the persons involved so that their data
are fairly reliable.

At last I found that tlie source for the misspelling of my middle name
was the Catalogue of the Library of Congress, where I appear on the
printed cards as Henry Ernst Sigerist, and the fact that these cards are
widely distributed in America explains the frequent misspelling. The
Library of Congress does not attempt to ascertain an author's correct
name. The arbitrary rule is “give forenames in the form most common
in the author's native or adopted language, or in doubtful cases, in the
form proper to the language in which he has written most of his tvorks."^
My first books were ^vritten in Switzerland and published in Germany.
Hence I became Ernst, and although my native language was French
and my adopted language is English, and although by now the majority
of my rvorks have been svritten in English J am and shall remain Ernst—
to the Library of Congress.

More complications arise when a name has to be transcribed into a
foreign alphabet. The first time I went to Russia, my name was entered
into the visa asCafirepnCT (Saigerist) because the clerk at the consulate
assumed that in English i was ahvays pronounced that way. The second
lime I became SnrepHCT (Zigerist), and the third time I put a slip into
my passport indicating the pronunciation of the name by transcribing it
myself. I am afraid I must have caused some trouble to the Commissariat
of Internal Affaire, but, efficient as they are, they undoubtedly made
cross references.

1 American Libniiy Association, Catalog Rules, Author and Title Entries, Chicago, Ameri-
can Library Association, 1941, p. 45.

294

ON THE HISTORY OF MEDICINE

Personally I have no feeling in the matter because I really do not care
what people call me If for some unknown reason the Library of Congress
chose to list me as Genri Ernestovich Sigerist or as Abu Erica Ibn Ernest
Henry Sigerist el Barizin, I would not have the slightest objection The
example, however, shows that it is sometimes difficult to ascertain a man s
correct name and that such seemingly authoritative sources as the Cata
logue of the Library of Congress are anything but reliable in this matter
and must be used cautiously and critically

THOUGHTS ON
THE PHYSICIAN’S WRITING
AND READING

I THINK it is an excellent idea to devote a number of this journal to
the problems of medical siting, although I am not quite sure that there is
such a thing as medical, chemical, physical, or agricultural witing. There
is good witing and bad tvriting no matter what you wite about, but I
know that many physicians, young and old, are puzzled and worried when
they have to write a paper. As an academic teacher who had to read stu-
dent papers, as editor of several journals whose daily task was the reading
and editing of papers, I know what enormous difficulties many doctors
experience when they have to express the result of their svork and ex-
periences in svriting. So there can be no doubt that a series of articles
devoted to this subject must be welcome.

There may be no medical tvriting in the strict sense of the word, but
it is obvious that the style varies according to the subject under discus-
sion. It makes a difference whether we wite a poem, a literary essay,
or a scientific paper. The language used also makes a great difference.
Cicero could svrite monster sentences and yet be perfectly clear. The Ger-
man language permits the use of long sentences •which seem obscure
chiefly to those who do not master the language. French is perhaps the
most elegant vehicle for carrying thought, scientific and othenvise, and
many French medical svritings, case histories of Charcot, papers of Pas-
teur, Claude Bernard’s Introduction a V£tude de la Mededne Expiri-
mentale are literary masterpieces. Fe^v countries have insisted so much on
style in scientific tvriting.

296

ON THE HISTORY OF MEDICINE

The English language is a marvelous instrument of precision and
clarity In English ive can develop our thought in short sentences which
fit together like the glass bricks with which we build a modem house
This does not mean that long sentences are impossible in English One
of the best stylists I know, Virginia Woolf, begins a superb essay, ' On
Being 111,’ ^ one that physicians would do ivell to read, ivith the following
sentence

Considering how common illness is how tremendous the spiritual change that it
brings how astonishing when the I^hts of health go down the undiscovered countries
that are then disclosed what wastes and deserts of the soul a slight attack of mflueiua
brings to view, what precipices and lawns sprinkled with bright flowers a little
of temperature reveals what ancient and obdurate oaks are uprooted in us by tb®
act of sickness how we go down into the pit of death and feel the waters of annib i
tion close above our heads and wake thinking to find ourselves in the presence of *
angeb and the harpers when we have a tooth out and come to the surface in
dentists armchair and confuse his 'Rinse the mouth-rmse the mouth with *
greeting of the Deity stooping from the floor of Heaven to welcome us-when *
think of this as we are so frequently forced to think of it, it becomes strange m «
that illness has not taken its place with love and battle and jealousy amons
prime themes of literature

This certainly is a long sentence but it is clear as crystal
ning to end and what a world it cvokesl One sentence makes us
ber all the illnesses we ever had Only a great poet can wite so well, an
we pedestrians must remain closer to earth

The tivo prerequisites for good writing, particularly on subjects s
as science and learning, are clear thinking and command of the
in which one writes I always found that people who thought clearly
able to express themselves clearly, be it orally or in ivnting I h^ve
many very poor lecturers, and they were invariably people whose
was confused, who jumped from one subject to another, began sente
Without finishing them, and in general were just thinking aloud
logically My otvn teacher m medical history, Karl Sudhoff of the
venity of Leipzig was one of them His knowledge ivas formidab e,
he simply poured it out over his audience, in an undigested way, a ^ ^
ivriting was often confused also A lecture, just like a paper,
beginning, a development, a climax, and an ending And let me a ^
every lecture, even if it is just a routine classroom lecture, s o
prepared very carefully I have been lecturing in many countries, m

l The essay u Included In the collection The Moment and Other Essayst
court Brace & Co , 19't8

THE PHYSICIAN’S WRITING AND READING

297

languages, for over thirty years, but still today I am frightened when I
enter the lecture hall. Of course the moment you face and address your
audience the fear disappears, and some magnetic bond is established
between yxiu and the people you talk to. At the end you are exhausted
because you have given yourself out. body and soul. I often thought that,
should I no longer be frightened before a lecture, that is, should I no
longer have the deep respect that is due an audience, any audience, the
lectures would soon become very poor.

IVhat applies to a lecture applies in a much higher degree to the wir-
ing of a paper or, still more, of a book. The audience you address is
larger and is not only today's but also tomorrow’s audience. When you
talk you have more license than when you write. In a lecture you may
use colloquial words which you must avoid in witing. You may begin a
sentence without finishing it if the following sentence takes up and
develops your thought. You may even, though one should not, use pro-
fane words to emphasize a point, but you should never do such things in
writing.

I think every wiier develops his own technique in the course of time,
and ] can discuss here only the advantages and disadvantages of my own
way of writing. When I have decided to tvrite a paper or a book I feel
“pregnant” with it for a long time, and since 1 have usually half a dozen
literary projects pending I feel “pregnant” ivith a whole litter. I have
the subjects constantly on my mind and make notes at any hour of the
day or night. I always have sheets of paper of uniform size handy, and
every evening I sort the notes and put them into their respective folders.
Then comes the day svhen you are ready to begin tvriting. Usually it is
some pressure from outside that determines the date, an irate editor who
reminds you that the deadline for your paper was three months ago, or a
publisher tvho has been waiting patiently for years for a manuscript but
would now like to have it very soon. Life is short but the art is long, and
one never feels quite ready to ivrite, being too much aivare of gaps in
one’s knowledge. Still, unless one is a hopeless perfectionist the day comes
when the paper has to be witten, and here the methods vary a great deal.
Some people are able to dictate a paper or even a book. They correct
what they have said, it is retyped, and the work is done. I am not one of
them and dictate only lectures that I wish to publish, lectures for which
I did a great deal of research and for which I have profuse notes. I never
Write a lecture before it has been delivered because a manuscript para-
lyzes me completely and also because I find that oral and written styles

298

ON THE HISTORY OF MEDICINE

are different This method has the great advantage that it improves your
lectures, because you have to think while you talk, which is usually not
the case when you read a manuscript, and because you talk to an audi
ence that is looking at you, not to unseen readers It has the disadvantage
as some of my friends have experienced, alas, that it may take some time
before they receive the promised manuscript because once the lecture is
over other demands are piling up on you

Some people ivrite a paper m longhand or on the typeivriter, then re-
svTite It several times until they are satisfied with it Emil Ludwig a pr(>
fuse writer, once told me that, when he had the materials for a boo
ready, he mote it very quickly m shorthand Every evening he sent v* at
he had mitten to a secretary who lived at the other end of Switzerlan
Two days later he received the typed script, corrected it, and thus ha a
book ready for the press in a very short time

My method of writing is very different, but it is one which has su
highly respected predecessors as Emile Zola. Guy de Maupassant, an ^
am sure many others Once I am ready to mite I make a short outline o
not more than one page, of the paper or, m the case of a book, o t
chapter Then every day I write a set number of pages m
final form, ready for the press, with footnotes and all that goes wit ^
IS a slow process, I mite in longhand m copybooks of folio ^
have made especially for me I mite on the right hand page only, the on^
to the left being left blank for footnotes and minor changes As a
mite five pages a day or about 700 words from 9 to 12 ocloc m
morning It is not much but lE you do it for 300 days a year you wi
duce quite enough literature The rest of the day you need for
for the preparing of next day's writing, for the correction o
proofs, correspondence, and an infinity of current affairs

I know it is generally recommended that scientific papers be as s
and as factual as possible As a result they are informative, to be sure ^
make frightfully dull reading 1 know of famous medical
which every article is edited or even remitten entirely by a hig J
petent staff of elderly ladies according to set standards, and the
that every article reads as if it had been written by the same penon ^
is just fatal No two individuals are alike, and no matter how ac
article is ive wish to get a grasp of the personality behind it
I said that the prerequisites of good writing are clear thin
command of the language in which you are mitmg The
spot, particularly in America We should expect that a medica s

THE PHYSICIAN’S WRITING AND READING

299

had acquired a thorough knowledge of English in college. Some have, but
very many have not. In America, not a few physicians are foreign-bom. I
am one of them, and I would like to give my colleagues a bit of advice.
Work to improve ytuir command of the language daily and quite par-
ticularly during the first yearsl After a while one acquires a rich enough
vocabulary to express oneself fluently, though with an atrocious accent
and making the same mistakes over and over again. 1 had the great ad-
vantage of having learned English as a child and of having spent some
lime in England before I came to America, but even so the change of my
literary language ^ras a great shock. I had nTttten papers in French and
Italian, very few in English. My first books were all written in German,
and I had developed my own style, winch was generally appreciated
by critics. All of a sudden from one day to another I found myself trans-
planted into the Anglo-Saxon world and knew from then on I would have
to write every line in English. I knesv the l.inguage well enough to write
a paper or to capture the attention of an audience in a lecture, but writ-
ing a book was a different matter. I had no trouble doing it but I felt that
the style was poor, and it still is not the style I had when I was writing
in German. Yet I worked on improving my langttage from the fint day
on and I am still doing it today after twenty-two years.

My method is very simple, and I can recommend it not only to foreign-
bom Americans but to everybody. It consists of reading good writers
critically. I happen to like Aldous Huxley; his style appeals to me very
much and I find that sve have many thoughts in common. When I first
came to America I look some of his novels— 1 had read them years before,
but now I reread them critically, a few pages a day only, analyzing the
sentences and making notes of words that I would nor have used but that
struck me as being very expressive, I also made notes of entire sentences,
and in this way in a couple of years I increased my vocabulary and im-
proved my syntax considerably. I still follow the method. The witers
vary, but I am more anxious than ever to improve my style.

This brings me now to the doctor’s reading. I know well enough that
his time is limited, but he should be the more critical in the selection of
his reading. I think everybody, no matter how busy he is, should spend
at least two hours a day reading.

What should the physician read, apart from professional literature that
he must read to keep abreast of a ^t-developing science? Before we
answer the question we must raise another one. To what end do we read?

I think the answer is to learn, to improve ourselves, to enrich our life and

800

ON THE HISTORY OF MEDICINE

make it more meaningful, and also to learn to express ourselves better We
do not read to kill time, because life is too short and time too precious to be
killed thoughtlessly There are moments, to be sure, that we would have
preferred not to have lived, an unpleasant illness or a tedious journey
These are the moments when there is time for a thriller, which makes us
forget ourselves, our environment, and everything, but I confess that I
never developed a taste for them unless they had real literary value
What, then, should the physician read? Quite generally, I may say, he
should read what other educated people read There are no belles lettres
for physicians and others for bankers I think it is a very good habit to
begin the day with a poem Most busy people, and physicians are busy
people, wake up in the morning when the alarm clock rings without
being quite rested Or they have taken a tablet m order to sleep have
slept deeply, but still do not feel quite normal When they shave they
remember what a heavy schedule they have ahead of them and wonder
how they will survive the day When they come down to breakfast they
already feel gloomy They open the paper and read that everybody hates
everybody else In this state of mind they go to the office and the days
drudgery begins Why not set the alarm clock ten minutes earlier and
before getting up read a poem or two? It will resound in you throug
the day and may change your entire outlook This morning I happened
to have Dante Gabriel Rossetti s poems on my table I opened the boo
at random and read

The blessed damozel leaned out
From the golden bar of Heaven
Her eyes were deeper than the depth
Of waters stilled at even
She had three lilies m her hand
And the stars in her hair were seven

After I had read the poem I knew that the day was going to be a
one, and indeed I wrote more than five pages without inhibitions
whenever something seemed to go ivrong I saw the blessed dafflozel t
her lilies and stars ‘ she bowed herself and stooped Out of the *
charm, Until her bosom must have made The bar she leaned
” And I remembered the music Debussy wrote to the poem “
in Rome at that time, laureate of the Rome prize, residing at
Media He was not happy there, although he liked roaming throng
eternal city and browsing m the numerous antique shops But he

his native Pans, and every year he had to send to the Pans

Conservatory

THE PHYSICIAN’S WRITING AND READING 301

of Music a cantata. He hated doing it to order but La Damoiselle Blue
v?as one, written in 1887 when he was twenty-five years old, and already
it had all the infinite charm that France’s great coming composer tvas
going to have. I have the tnusic on very good records, played them, and
thus due to a few venes read in the early morning I had a perfect day
during which I did more work than ever.

Another day I woke up and heard the rain pouring down. It was not
dramatic rain with clouds piling up behind the hills as for a scene in a
Wagnerian opera. The world tvas 5n gray, and it was going to rain steadily
for twenty-four hours. I have a small but select library next to my bed; I
took out a volume of the poems of Paul Verlaine, read;

It pleuredam moncocur
Comme il pleut sur la ville.

Quelle cit ccue langueur
Qui pinttre moti coeur?

Again I Tcmcmbered the music that Debussy had svritten to these lines,
and again a day which might have been one of gloom became a festive
and roost productive day, in spite of the monotony of the pouring rain.

I think another bit of sound advice is that one should never read the
newspapers and roagaeines before having read at least fifty pages of a
worth-while book. Of coune we must read newspapers because as citi-
zens of democratic countries we must keep informed of world affairs. 1
read at least five papers every day in four languages, but I find that not
more than half an hour is needed to get all the news we are interested
in. Most articles arc a mere repetition of the headline, and once you
know the event and the party line of the paper you need not read the
editorials either. They are given, and you could wite them yourself just
as tvell. The same applies more or less to journals, and while we ob-
viously cannot ignore them we should not spend too much time on them.

What then shall the physician read? Any good book vn-itien during the
last 5000 years. It is a great mistake to read only new books. Of course
W’e ^vant to know ^vhat is being ■written today in \’arious countries, ho^v
contemporary writers see and recreate the world of which ^ve are a part,
hfany such new books turn out to be very poor in spite of much publicity
and large editions. At least one half of the new books I read are not
■svorth the time spent on them. We fare more safely with the classics,
books that have stood the test of time. Apart from my professional read-
ing, which obviously is quite extensive, I read about 100 books a year
and I keep a record of them. At the end of the year I find invariably that

302

ON THE HISTORY OF MEDICINE

one third were books tvritten before 1900, many of them before 1500,
one third were written between 1900 and 1940, and one third were new
books many of them copies presented by their authors
There is much talk in America today about The Great Books the
hundred great books of St John s College, the great books published not
so long ago m new editions and translations under the auspices of the
University of Chicago Clubs have been organized in many cities where
people from all walks of life come together to read and discuss the ivorks

of Plato Thomas Aquinas Descartes, and other great writers of the past,

who have left such a deep imprint on Western thought This certainly
IS a development about which we can only rejoice as it means that
America is coming of age I know of many businessmen and also physi
cians who are attending the meetings of these clubs and I think it would
be very interesting to find out after about ten years what effect the study
of these books has had on them Has it changed their general outlook
their attitude towards life and the world at large have their actions be-
come different? This is extremely important because the ideologic con
flict of our time is not one between political and economic theories but
between materialism and spiritualism I cannot discuss this point in any
deuil as it would require another essay I may only say that in my op*”
ion the ideologic conflict between West and East is not one between the
United Stales and Russia but rather between the United States an
Russia on one side and India and other Asian countries on the other side

The study of the great thinkers of the past undoubtedly is very im
Ldiii as It will help us to acquire a more correct sense of values
will teach us that the accumulation of technical gadgets and materia
goods in general is of no importance, that it is better to be wise than to
be rich that there is no point m being the wealthiest corpse in t
cemetery It will teach us that freedom is a matter of the mdividua an
has very little to do with political institutions You are free u'hen you a
free from material needs and free from passions A man whose
full of ambition and hatred is a slave even if he lives in the so-ca
‘ free world

One should begin early with the reading of the world s classics I rea^
hundreds of them in the formative years from twelve to twenty
I have kept reading and rereading them to the present day I have a
library of about 500 volumes next to my bed books from all coun
and m many languages They are the books that have accompanie
through life and that I would not like to miss Greek and Chinese c

THE PHYSICIAN'S WRITING AND READING

303

sics, German and Indian philosophers, Russians from Gogol to Chekhov,
the French classics, the Don Quijote, Goethe, Stefan George, and Rilke,
and of course the great English poets, books on music, particularly on
Mozart and Debussy, and books on art, ancient Egyptian, Babylonian,
and Arabic poetry, the rvorks of some great naturalists such as Alexander
von Humboldt and Charles Danvin. It is a small section of my library,
but one carefully selected, that I love, and it is my daily or rather nightly
delight.

To us tvho gretv up in Europe in the beginning of the century, it was
so easy to get hold of the great classics of the world. In Germany, Reclam’s
Universal-Bibliothek. offered practically everything one could wish for
for a few cents, not only the Greek and Latin and later European classics
but the main literature of the Arabs, Persians, Indians, and Chinese.
Many of these books could be got from slot machines in raihvay stations.
France had innumerable series of classics of the world’s literature which
were sold very cheaply, and in England we had the Everyman’s Library,
the Wisdom of the East series, and many others which provided students
with excellent texts for very little money.

One point I should like to mention in this connection is the speed of
reading. I know that American schools try to teach their students to read
as quickly as possible. I have a daughter in America who reads a book
in one day which it would take me four to five days to read. If the physi-
cian can devote only two hours a day to reading, it is obviously important
for him to be able to read much in a short time. I am a hopelessly slow
reader and therefore probably prejudiced in the matter. When I read a
book and a paragraph strikes me as particularly good, I may read it
several times and make notes about it. I wonder if studies have been
made with quick readers to find out how much they remembered of
what had particularly impressed them in a book, after five, ten, or fifteen
years. Some books we wish to forget as soon as possible as they are not
worth being remembered, but others we svant to assimilate, want them to
become part of ourselves, and this takes a certain time.

Many of those svho have had the patience to read this essay to the end
will think that I am a hopelessly pedantic schoolmaster. Maybe I am, but
what I svrote I have lived, and it has enriched my life so tremendously
that I thought that others might benefit from my experience.

INDEX

Abortion, andent atdcudc toward, 58
Christianlt}' and, 39
Abu'l Kasim, 127
Achillinl, Alessandro, 160
Ackerknecht. Erwin II.. 243, 248
Adami, Georfe, 209
Adams, Frands, 103
AStius of Amida, 102
Agrjcola, Ceor^us, 90
Albrrtus dc Zanoriis, 131
Albortus Magnus, 129
Alexandria, anatomy and, 155'156
Alexandrian Library, the Corpus Hippo-
mticum and, 112
Alfonso VI of Castile, 124
All ibn el-Abbas (Haly Abbas), 129
Alkmaion, 107
Alston, Cbailes, 205
American Association of the History of
Medidne, 237, 247, 248
Anatomy, in Alexandria. 155-156
in ancient Egypt, 156
In andent Creek medicine, 155-156, 157
in the eighteenth century, 42, 161
Harvey and, 189-190
in the nineteenth century, 161
in primitive medidne, 156
in the Renaissance. 40, 155-I6I
In the seventeenth century, 41-42, 161,
190-191

Vesalius and, 186-187

Andent Egyptian medidne. anatomy ia.

356

canttr in, 59
gynecology in, 57
ocaipational hazards and, 47
physidans, 5
specialiution in, 12
Ancient Greek medidne. 28, 29
anatomy in, ]55‘156. 157
Arabic translations and, 121, 122. 124-125
cancer in. 59, 61, 62-63
the Corpus Hippociatinim. 97-119
disease in. 60
empyema in, 64
gynecology in. 98
hygiene in, 19-20
occupational ailments in. 47-48
patient in, 27

physicians in. 5-6. 28-29, 31, 109-111
Ancient Oriental uedidne, cancer In, 59
bygiene in, 18-19

Andent Roman medidne, and Hippoc-
rates, 113
hygiene in, 20
physidans in, 7-8, 31
specialization in, 12
Antoninus Pius, 31
Apollonius of Kition, 105
Arabic, translations into, 121, 122, 124-125
Aianrio, 40
Aristarchus, 85, 157

306

INDEX

Anstotle, 38, 166, 185
Amald ot ViUanova, 129, H7. 210
De Cautelis Medtcorum of, 131 140
Asklepios, 5, 28, 99
Auenbruggcr, Leopold, 82, 88 89
Augustus, 31
Auscultation, 82
Avicenna, 115, 128 129, 166

Babylonian mcdiane, cancer in, 59
physicians in, 4 5, SI
Bacon, Roger, 129
Baglivi, Giorgio, 84
Baissette, Gaston, S9 100
Bard, Samuel, 207
Baudisch, Oskar, 73, 76
Becker, Carl L . 250

Bedside manners, to medieval medicine.
ISl 140

of medieval surgeons, 143 145
Bell. John, 70
Bencdetti. Alessandro, 160
Bernard, Claude, 296
Bichat, Xavier, 42, 64
Bier, August, 65 117
Biggs, Hermann T , 16
BUlings, John Shaw. 235 236 237, 239
Blood, discovery of circulation of. 86 87.
184 192

Bede, Mabel, 254

Boerhaave, Hermann, 89, 193 201. 234
American medicine and, 195 196, 202 208
Austrian medicine and, 196
biographical sketch 196 201
German mediane and, 195
personalu^v of, 202 205
Scottish medicine and, 195
Boll. 108

Bond. Phineas, 204
Bond, Thomas, 207
Bonei, Thtophile, 42
Boretll, 91

Bourgeois Louise, 42
British East India Company, 218
Brown, John 208, 234
Bruno Giordano, 41
Bull William, 204, 205
BuTckhardt, Jakob. 158, 253
BurdigalensJs, Marcellus, 123

Bums, Ambroisc Park’s onion treatment of,
177 183

ink treatment of. 177
Catttni, 87

Caelius Aurelianus, 123
Campanella, 41
Cancer, in ancient Egypt, 59
jn ancient Greece, 59, 61 65
ancient therapy for, 61 62, 63
in Babylonia, 59
early theories on. 62 65
in the Middle Age*. 59
occurrence of, 59 61
Casseno, Ciuho, 161
Cassirer, Ernst, 159
Castiglioni, Arturo, 117
Cel5us.48.61,274
Cervantes, Miguel, 503
Chadwick, 44
Chamberten, 42
Charcot, Jean Martin, 295
Chekhov, Anton, SOS
Childbirth, theories on, 36 37
Child welfare, ongin of, 22
Christianity, hygiene and, 20
and impotence, 146 147
and medicine, 8 9
patient and. 27. 28, 29 30
women’s position and, 38 39
Chrysippus of Cnidos, 100, 112
Circulation of blood, discovery ol, 1^4
Qinical thermometer, development of. 89
Cloetta, Professor, 259
Clowes. William, 179 180
Code of Hammurabi, 5, 31
Codex Urbinas, the, and the Corpm Hip
pocraticum, 109
Cohnheim, 65

College of Philadelphia, medical depart
menl of, 203, 204. 206 208
Colombo, Realdo, 160 188
Comrie, John D , 194 195
Comte, Auguste, 97
Conant, James B , 249
Constantine the Afncan, 124. 127, 1
Coutagium, theory of. S3 66
Contraception, Christianity and 39
Copernicus, Nicholas, 85, 91, 161
Cordell, Eugene, 236, 239 240, 247

INDEX

307

Comeliut Agrippa, <0
Corpui HJppocmtfcutn, the. 57-119
On Airs, WelfTt, Platts, lOG. 110. IH
the Alexandrian library and. 112
On Ancitnt Aferfidne, lOQ
Aphorum, JOMM. JJJ
author* of. 105-lOC, 109-109. 111-115
Codrt Prognoses, 111
and the Codex Orblnai. 109
dieieiio, 1|2
diseatei. 105
editions of. 100-102
Epidemics, 103. 113-lU
On Bpiltpsj, 107.114,116
Epistles, 109
fever In, 116
On Fraeturet, 108
geographic ohservatiom In, 107
gynecology, 103. 108
Hippocraticoath, the. I09-I1I
UiitnoTS, 114
Inflammation in. 116
On Joints, 108
medieval medicine and. 115
nature of Man, 114
prognosii In, 106. llO-tIf
in thf Jltssihsastet, J 15
lurgery, 108, 114
tramUtion* of, 102-103, 115, 122
Treatise on Rabies, 109
On Winds, 112
Corviurt, 88-69
Crawford, Jamei, 205
Croce, Benedetto, 159
Crommelln, C A., 199
Cullen, William. 208, 234
Cumroingj, Alexander, 2J6
Cushing, Harvey, 238, 249

D'Abano, Pietro, 129
Oa Carpi, Berengario, 100
Darcmberg, Charles. 194, 195
Darwin. Charier, 92, 303
Davidson. Edward C., 182
Da Vinci, Leonardo, 40. 158-160
De Brume, Slotemaker, 194
Debussy, Oaude Achille, 300-301, SOS
De Cauielis Medicorvm of Amald of Villa-
nova. tsi-ua
De Graaf, 4l
De Haen. Anton, 89, 196

DelchgrSber, Karl, 106, 109, IlS-114
DeLlnt, J. C., 198

De Longchamps, Pcnnier, fils, 283-285
De Maupassant, Guy, 293
De Mondeville, Henri, 142-145
Deseasses. Rend, 4J, 91
Diagnosis, theories of, 161
Diels, Hermann, 100. 108, 109
Oiqjgen. Paul, 152. 154 . 195
Diller, Hans. 106, 109
Dinger, 196
Diocia of Karystos, 19
Diosrorides. 122, 124
Disease, and the doctor. 269-281
theories on origin of, 17. 161
Diseases, industrial and occupational, his-
tory of, 46-56 •'

DrabUn. I. E.. 243
Dubois, luac, 55, 204
Duhero, Pierre, 158
Dunglison, Robley, 234
Dutch East India Company, 218
Do Tertre. Marguerite, 42

Edelstefn, Ludwig, 6. 106-107, 110. Ill, 112,
113,114, 242

Edwin Smith SurginJ Papjras, J5S
Ehrlich. Paul, 59

Eighteenth century, anatomy in. 42, 161
Boerhaave'f influence on medidne in,
193-208

cancer theories in, 64
England, literary eontroversy over tea in.
218-229

France, truffles in, 283-285
gynecology in, 42-43
hygiene In, 21-22, 216
medical-hrstory studies in. 234-235
medical thought in, 191
medicine in. 32-35
occupational diseases in, 51
physirians in, 11, 12
proper names in. 291
public health in, 220-221
sdentifle progress in, 91
Einstein, Albeit, 92
Ellenbog. Ulrich, 49
Empiridsts. 1S7

EtsgUad, ocaipacianal medidne in, 54-55
public health in eighteenth century, 23
Eiasutiatus, 112. 155, 156

308

INDEX

Erasmus, 40, 171

Erotianus 113

Euryphon, 112

Evolution, theory ot, 92

Experimental method, Harvey and, 189

Fabnaus of Acquapendente, 160 161, 187
Fallopio, Gabriele, 40, 160
Farmer Fannie Merritt, 290
Faust, Bernhard Chnstoph, 22
Fees, ancient establishment of. 5
in ancient Greece, 29
in ancient Rome, 7
in the nineteenth century, 12
in the Renaissance, 30
Fehmers, C . 201
Fcrdinandus Epiphanius, 84
Filatova, A G.ISS
Flu, P C . 194

Fracastoro, Girolamo, 80, 187
Francis W W . 237
Frank, Johann Peter, 21
Franklin. Benjamin, 22
Frederick II, 31. 32, 127
Frederick the Great. 195
Frobenius, Leo, 171, 173
Fuchs Robert, 103
Fulton, John T , 238, 249

Galen. 48, 59, 62, 101, 102, 113. 122. 156.
166. 177

on circulation, 185 186, 187, 189
and Hippocrates, 115
Galileo. 87. 91

Garnson. Fielding H , 233, 241, 243
Geoffrey, Claude-Joseph, 284
George, Stefan, 303
Gerard of Cremona, 125, 128
Germany, occupational diseases m, 55 56
sickness insurance in, 13 14, 33
Giuflri, Liborio, 117
Goethe. Johann IVoIfgang von, 303
Gogol, Nikolai, 303
Goldsmith, Oliver, 227 228
Government, patient and, 27 23
public health and, 32
Gratian, 146

Greece, see Ancient Greece
Group medicine, development of, 13
Guilletneau, 41
Gutmann, Margit, 105

G^ecology, in anaent Fgypt, 37
in ancient Greece, 38
in the Corpus Hippocraticum, 103
developments and trends In, 34 45
m the eighteenth century. 42-43
in the Middle Ages, 39
in the nineteenth century, 43 44
in the Renaissance, 40-41
in the seventeenth century, 41 42
social aspects of, 44 45

Haeckel. Ernest, 254
Haldane, J B S , 267 •

Malsted, William S . 233
Hanway, Jonas 219 229
Harding. T. Swann, 288
Hanngton Sir John, 209 216
Hanin al Rashid. 123
Harvey, William. 41. 86 87, 91. 97, 184 192
anatomy and, 189 190
biographica) sketch J87I63
European thought and, 184 192
experimental method and, 189
Hauriau, 132

Health and Morals Apprentices' Act (The)
of England, 55

Health insurance iR United States, 72
Hccquet 55
Heiberg. 1 L , 191
Heidcl, William Arthur, 116
Heliotherapy, 73

Hellenism in the Middle Ages. 120 ISO

Menie, Jakob, 85 86

Henry, Charles 89

Henschel, 133

Hero of Alexandna, 88

Herodikos, 112

Herodotus, 37

Herophilus, 155. 156

Herrog Rudoll, 99

Hildanus, Fahrmus 181

Hincmar, Archbishop of Rheim*,

Hippocrale, 118

Hippocrates 88. 47. 60. 97 119. 292. 234
and the Corpus Hippocraticum,

Galen and, 115
sdiool of. 5 6

fee also Corpus Hippocraticum
Hippocrates, 118
Hiischfeld, Ernst, 133
Hirscbfeld, H, 254

INDEX

S09

Hinch>ogeI, Augujtin, 162
ffijtory, la'cnce and, SiJ-95
Hofcr, Johannw. 82
Hoffmann. Cerda. J47, 150
Honigroann, Georg. 1!8
Hubaysh, 122
Hume. Edward II., 2H
llunayn ibn hhaq. 122, 125
Hunger. F. \V. T.. 198-199
Ilunicr, John, 63-61
Hunter. -Wmiam. 45

Huxley, Aldous.299
Hjgiene. In ancient Greece, 19-20
In anci'ent Rome, 20
In the eighteenth century, Sl-22, 216
In the Middle Ages. 20-21
in the nineteenth century, 22-23, 216
philosophy ot. 16-24
religion and. 17-20
In the Ren3fiunce.2[
in the liateenih century, 209-216

Ibn at-Jamr, 127
llberg. 1, 100. 102. 103
Imhotep, 5

Impotence, witchcraft and. U6-I52
Industrial diseases, history of, 46-56
Industrial Revolution, 92
medicine and, 32 35
public health and. 22
women and. 43-44

Infant welfare in eighteenth century Eng-
land, S20-221

Institute of the History of Medicine at the
University of Leipzig, 234, 259-261
Isaac. 127
Ishaq. 122

Jacobs. Henry Uarton, 238
Jacoby, Gerhard. 107
Jefferson, Thomas. 234
Johns Hopkins Institute of the History of
Medicine. 234. 241-247, 261-262
Johns Hopkins Medical History Club, 236
Johnson, Samuel, 225-227, 228
Johnston, Lewis. 204 , 205
Jones, W.H, S.,101
Judaism, hygiene and, 18, 19
Julius Caesar. 31
Juvenal. 48

Kahun, gynecologic papyrus of, 36
Keffy. ffoward A.. 233, 238
Kepler, Johannes, 91
Rircher, Athanasius, 84
Klaaww, C. J. v. d„ 199
Klebs, Arnold C. 238, 249
Koch. Robert. 58. 59, 66, 103
Kovatenofc, A-, 182
KOhlewcin, II.. lOO. 102
Ktfhn, Adam. 207, 234
KOhn, G. C., 101

LaSnncc. Renf, 42, 64, 82
lalgncl-Lavastin^ 118
Lambert. £. R.. 288
Lanfnnchl, 62
Lang. Arnold. 254-255
Langevin. J.. 267
Larkey. Sanford V.. 243
Lavoisier. Antoine Laurent, 86
Leake. C.D.. 243
Leibnitz. Gottfried Wilhelm, 41
Lejumeau de Kergaradec,42
Le Jeune. Ceoffroy. 284
Leoniceno, 166
Leonides. Cl
Levy. H., 267
Libman, Emanuel, 245
Lindsay, Jack, 216
Linnaeus, 200

LUtrf. Emile. 97, 93. 100, 104-105
Loeb. Jacques. I02-I03
Lucretius, 48
Ludwig I of Savarla. 195
Lutz. H. L. F.. 243

Maas. 196

MacUnney. Loren C., 250
Magic. 28
Maimonides, 129
Manardus, 166

Maria Theresa of Austria, 196
Kfaritwart. Otto, 253
Martial, 48
Mauriceau, 42
McClellan. Walter S , 76
McDowell, Ephraim, 43
Medical bblory, in ibe nineteenth century,
235-259
study of. 251

in the twentieth century, 239-250
m (he l/ntCed States. S33 250

310

INDEX

Medical journals, Hippocratic, 118 119
Medical literature, historical collections,
237 258, 241 250

medieval contributions to, 128 129
medieval medicine and. 123 124 127 128.
129

translations from Greek, 120 128
translations into Arabic, 122 124 125
translations into Latin, 123, 124, 125, 127
Medical schools medieval 9 10, 127 128 ♦
methods of teaching 263 267
teaching of medical history in, 235 236,
239 240, 246 250

in the United Stales 203 204, 206 208. 234
Medical societies, development of, 14
for medical history studies, 236 237
in the Roman Empire, 7
Medicine, baroque concept in, 190 191
Christianity on 8 9
in the eighteenth century, 32 33
natural saences and 11 13
in the nineteenth century, 83, 235
religion and 28
the Renaissance and, 158
scope of, 3

as social saence, 25 33
time onentation of 82 93
Medieval medicine, 28
Arabic medicine and, 127, 129 130
assimilation and, 125 128
bedside manners m 131140
cancer and, 59

the Corpus Hippocraticum and, 115
gynecology and 39
hygiene and, 20 21
impotence and 146 152
literature of. 123 124 127 128 129
occupational diseases and, 49 50
patients and, 26
physicians and, 8 11, 29
public health and, 32
revolt and, 129 130
sources of 120 ISO
surgical practices, 141 145
synthesis and, 128 129
transmission and, 121 125
see also Middle Ages
Menon, 112

Menstruation, taboos and, 36
Metal poisoning in ancient Greece, 47 48
in Middle Ages. 49

MethodicistJ, 157
Miasma, theory of, 85 86
Michelangelo, 86 87
Middle Ages Hellenism in, 120 130
spas in, 66 67

see also Medieval medicine
Midwifery, 57

Miller, Genevieve. 234 248 244
Mineral spnngs, see Spas
Mining occupational hazards of 49 51
Mitchill. Samuel Latham. 285 287

Moli&rc, 41

Monro, Alexander, 205
Montpellier, medical school at, 128
Morgagni, Giovanni Battista, 42, 55, 6 , .

Mo^n, John, 206 207, 284
Moslem Empire, conquests of. 124 125
medicine in, 126 128, 129 150
origin of 121 122
Mozart. Wolfgang Amadeus, SOS
Much Hans 117
Mliller. Johannes, 64 65
Mustio, 39, 40

Nachmanson, Ernst, 107
Names, spelling of, 291 294
Natural sciences, medicine and, l .
Needham, J . 267
Neumann, S , 27
Newton Sir Isaac, 41 91
Nicaise. Edouard 142

Nicholson, Samuel, 204. 205

Nineteenth century, anatomy m,
cancer theories in 64 65
gynecology m. 43 44
hygiene in. 22 23. 216
medical history studies m. ^33
medicine in, 35, 235
occupational diseases m, 54 a
phvsicians in, 11 12
proper names in. 291 ^
aaentific progress
surgery in, 43
Noguchi. Hidcyo. 245
Nuyens, B W T , 199

Obstetrics see

Occupational diseases. 243

Oliver. John Rathbone, 255. 24
Olschkl. 159

INDEX

311

Onions, treatment of bums with, 1?7'I83
Oribasius, 115. 123
Origincs, 39

Osier, Sir William, 16, 233, 236. 237

Padua. University of, anatomy at, 160-161,
187

Pagel, J. L.. U2
Palfyn, Jean, 42
Pansa, Martin, 50
Papyrus Ebers, 59

Paracelsus, 49-50. 67. 80. 90. 162-176
biographical stetch, I62-I67, 170-173, 175
Defensiones, 175
Paregranum, 173-174
position of. 175-176
on syphilis, 174-175
theories of. 167-170, 171-172. 173-175
traveb of, 167

Volumen Paramirum, 168-170
Pat<. Ambroise. 40
onion treatment of burns, 177-183
Pasol, Blaise, 41
Pasteur. Louis, 86, 293-296
Pathology, history of, 58
Patient, Christianity and. 28, 29-30
the doctor as, 269-281
government and, 27-28
in Middle Ages. 26
physician and, 50-33
position of in andent Greece, 27
in primitive medidne, 26
Patissier, Ph.. 55
Paulus of Aegina, I2I
Paynell, Thomas, 230
Penning, C. P. J., 199
Percussion, discovery of, 88-89
Perkins, ^Vilma Lord, 290
Peter the Lombard, 146
Peter of Palude, 150
Pftrequin, J. E., 108
Peypus, Friderich, 174
Peyrihle. Bernard, 64
Philosophy, science and. 80-81
Physidan, the, in andent Egypt. 5
in andent Greece, 5-6, 28-29, 31, 109-111
in andent Persia, 31
in andent Rome. 7-8, 31
in Babylonia. 4-5.31
in Colonial United States, 203
in the eighteenth century. 11. 12

establishment of standards for, 31-33
history of profession of, 3-15
in the Middle Ages, 8-11,29, 141-145
in the nineteenth century, 11-12
patient and, 30-53
as priest, 4

and primitive sodety. 4, 28-29
in the Renaissance, 29-30, 31-32
svriting and reading of, 295-303
Physiology, origin of, 191
in the seventeenth century. 161
Pitcaime. 193
Plato, 5. 38
Pliny. 47. 48
Plummer. Andrew, 203
Prasagoras, 112
Preventive medidne, 16-17
Primitive medicine, anatomy In, 156
character of. 3
occupational diseases in, 46
patient in. 26
physidan in, 4, 28-29
Prosser, Samuel, 216
Proust, Marcel, 277
Ptolemy, 85

Public health, advances in, 33
in the eighteenth century, 220-221
government and, 32
in the Middle Ages, 32
occupational diseases and, 51-33
Pugh. John. 227
Puttier, C, 109
Pythagoras, 19

Ramazsini, Bernardino. 51-53. 55
Redman, John, 204, 206, 207
Regenbogen. 107

Religion, female fertility and, 35-36
hygiene and, 17-20
medidne and. 28

Renaissance, the, anatomy in, 40, 155-161
she Corpus Hippocraticum and, 115
gynecology in, 40-41
hygiene in, 21
medidne in. 155-183
physidan in. 29-30, 31-32
sdenti&c progress in, 91
^as in. 66-67
surgery in, 40-41

William Harvey and European thought,
184-192

312

INDEX

vroman’t position in, 39 40
Reputation, physiaan and, 29
Rhazes, A1 Razi, 126
Riditer, 158

Rilke, Rainer Mana, 305
Roentgen, Wilhelm, 89
Roentgenograms, discovery of, 89 90
Roger, H . 61. 104
Rooseboom, M , 199
Roscher, W H, 108
Rossetti, Dante Gabriel, 500
Rbsslin, 39

Rousseau, Jean Jacques, 22
Rush, Benjamin, 22, 203 206, 207, 208. 2J4
Russia occupational mediane in, 56
sickness insurance in, 14, 33
Rutherford, John, 205

St Clair, Andrew. 205 v

St. C6me et St Damien, ColUge de, 10, Ml
Salerno, medical school of. 9 10. 31 82, 127
128

Santono Santono, 86, 89
Sarton, George, 257
Sauerbruch Ferdinand. 255. 256 257
Schaudinn, 59
Scheffer, £ . 287 288
Scheuctuer, J J . 82 63
Schleiermacher, W , 108
Schoute D , 194 195
Science history and, 80 93
time onentaticn of, 82 93
Sedgwick. William T , 16
Sellheim 44
Senn.G. 116-117
Servetus Miguel, 188

Seventeenth century, anatomy in, 41 42, J61,
190 191

baroque art in, 190
cancer theories in 63 64
on nrculation of blood, 187 190
gynecology in, 41 42
medical thought in 190 192
occupational diseases in, 51
physiology in, 161
tea drinking in, 218
Shamanism, 28
Shippen, William, 207, 234
Shryod:. Richard. 249 250
Sickness insurance, development of, 13 14,
33

Siegemundin, Justine, 42
Sigenst, Henry E , 194
autobiographical sketch. 251 231
on the doctor as patient, 269 281
on the physician’s wnting and reading,
295 305

Simon Baruch Research Institute, 74 76
Sims, James Marion, 43
SiKCeenth century, on arcuhtion of Wood,
186 167

hygiene in, 209 216
philosophy in, 190
Smellie. William, 43
Social legislation in England, 55
Soaal saence, medicine as 25 33
Soranus, 114, 123

Spas in hisioncal perspective, 66 79
Speculization. 266 267
development of, 12 15
Sprengel, Kurt, 152
Steno. 41

Stevenson, J A , 288
Sucker. Georg 99,116
Stockhausen, Samuel, 50
Streeter, £ C.249
Studying metbodt of. 263 26?

Sucblandtus, 50

Sudholl. Karl. 163, 234 257, 259 261. 296
lor cancer, early practice of 61 62
Surgery, in ancient Persia, 31
in the nineteenth century, 45
Paracelsus on, 162
practices in medieval l41 145
in the Renaissance. 40 41
responsibilities m, 5
Sydenham, Thomas, 51, 202. 208, 254
Syphilis, Paracelsus on, 174 175

Taboos and women, 56 ^

Tea, literary controversy over, m dg ^
century England, 218 229
Temkin, Owsei. 107, 115, 116 242
Thackrah, C Turner, 54 55
Theodonc, 125 142
Theodorus Pnscianus, 123
Theophrastus 117
Therapy, anaent. of cancer. 61 62,
health resorts in, 76-79
history of. 58
mineral springs in, 72 74
theories of, 161

INDEX

313

Thiersch, 65

Thompson, G. Raynor, 245
Thorndike, Lynn, 250
Time factor, medical theories and, 82-95
ToUn, B., 182

Toledo, medical school at, 128
Torinus. Albanus, 160
Toroptsev, I. V., 182
Truffles, American, 282-290
in eighteenth century France, 283-285
Tuberculosis, prevention of, 23
Tuke, Samuel, 229
Tuke, William, 229

Twentieth century, cancer theories irt. 65
medical-history studies in, 239-250
occupational medicine in, 56
scientific progress in, 91-93

United States, Boerhaase and medicine in,
f95-I96. 202-208
colonial physicians in. 203
early public health in, 22
health insurance in, 72
medical-history studies in, 233-250
medical schools in, 203-204, 206-208
occupational medicine in, 56
spas of, 66-79
cruflles in, 285-290
Univenities In the Middle Ages, 123
Ursinus, Leonardus, 50
Uterus, theories on, 36

Van Bennebroek, Mejonkvrouwe Willink.
193

Van Beuren, John, 204, 205
Van Deventer, Henrik, 42
Van Horne, 41

Van Swieten. Gerhard van, 196. 203
Vasari, Giorgio, 158
Veith. lira, 244

Venereal diseases, prevention of, 23

Verlaine, Paul. 301

Vesalius, Andreas, 40, 42, 91, 97, 160-161
anatomy and, 186-187
Villcrrad, 44. 55
Vindidan. 123
Virchow, Rudolf, 11, 42
Von Beust, Fritz, 252
Von Halier, Albrecht, 81. 200, 203, 234
Von Hohenheim, Philippus Theophrastus
Aureolus Bombastus, see Paracelsus
Von Hohenheim, Wilhelm Bombast, 164-
166

Von Humboldt, Alexander, 303
Von Muller, Friedrich, 255-255

Waldeyer, 65

Water closet. Sir John Harington and, 209-
216

Weed. Lewis A.. 241

IVelch, William H., 15-17, 195, 235. 241, 245,
246.261,278

Wellmann, Max, 105, 107, 108
WenAebach, Karel Fredenk, 194, 196
Weyer, Johann, 151-152
Wllaroowitz, 107
Wiseman, Richard, 180-181
Witchcraft, 28
impotence and, 146-152
Wdlfflin, Heinrich. 190
Women, in ancient Greece, 37-38
Qirisiianity and, 38-39
Industrial Revolution and, 45-44
position of, 85-37
in the Renaissance, 40-41
Woodward, Dr., 22
Woolf, Virginia, 296

Workman’s Compensation Act in England,
56

Zerbi, Gabriele, 150
Zola, Emile, 298

ABOUT THE AUTHOR

Henry E. Sigerist, M.D., considered by many to be the greatest medi-
cal historian of our time, if not all time, was bom in Paris in 1891. At
an early age he was attracted to the study of languages. By the time he
was fifteen, be was well versed in French, German, English, and Italian
and was familiar with Greek, Latin, and Arabic. Shortly thereafter, he
expanded his studies to include Hebrew, Chinese, and Sanskrit. Dissatis-
fied with the limitations of philology, he turned to science, and finally
to medicine, to receive his M.D. at Zurich in 1917.

In his own words, "I refused to specialize. My interests were very
broad, and I drifted into a field where I could combine all my interests:
medical, philological, historical, and sociological.” Ultimately Dr. St-
gerist did become a "specialist,” in that he was one of the few dynamic

medical historians of all time. , . • t

Dr. Sigerist emerged supreme in his field after refusing the advice of
his colleagues, who called the history of medicine "a hobby for retired
practitioners.” From his study of the history of medicine grew his angi-
nal and ingenious theories on the true purpose of medicine and its value
to mankind. The medical world eventually came to accept
ideas and concepts and saw fit to award him many vrel- eserve >

including the Sudhofi and Welch medals for outstanding achievement.

He held many important posts, including those of Professor of the
History of Medicine at the University of Leipzig . / •,

Institute of the History of Medicine at the Johns Hopkins J'

In 1947 upon giving up the post at Johns Hopkins, „

Research Associate by Yale University, a position rohtch he held m
absentia after returning to Switzerland to orritc a mu
of mediclL. He also sLed as Pror’iortif
the History of Medicine and as President of O’

■ °T?the disappointment of many. Dr. Sigerist ^ff^^J^TctTlfl
only two volumes of his projected eight age of

health and, finally, his untimely death on .’ ’„tal task,

sixty-five, ended his hope of the completion of “ 1 ,;^ many

Despite the fact that his greatest project remai fi ^

inspired writings remain as a limng tribute ^ elated in the

dedicated humanist and historian and a of medical

Introduction to this book, "No one will again be able to write j
history uninfluenced by Sigerist's ideas.

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